Complex regional pain syndrome: a narrative review for the practising clinician

Abstract

Complex regional pain syndrome (CRPS) is a life-altering condition that usually affects the extremities after a trauma or nerve injury. The physiologic changes that occur as a result of the inciting injury are complex, as the name of the syndrome implies. The pain and disability associated with CRPS often lead to psychological co-morbidities that create a vicious cycle of pain, isolation, and depression. We review recent developments in the understanding of CRPS and advancements in management of this syndrome. Further research in targeting specific mechanisms involved in the pathophysiology of CRPS should lead to prevention of this condition.

Intramuscular Injection and Complex Regional Pain Syndrome Development After “Harmless” Procedures

“…Aggressive, timely management is imperative for delivering positive CRPS outcomes. Common examples include physical therapy, neuropathic pain medication, anti-inflammatories, bisphosphonates, sympathetic nerve blocks, and direct neural stimulation [4,17]. Sympathetic blocks are often insufficient for most patients, and epidural clonidine may reveal adverse effects in addition to benefits [7].…”

Efficacy of adjuvant dexmedetomidine in supraclavicular brachial plexus block for intractable complex regional pain syndrome: A case report with a 3‐year follow‐up

“…Complex regional pain syndrome is a chronic neurological condition, which may develop after peripheral nerve injury (type 2 CRPS) or tissue injury, such as fracture, contusion or sprain, combined with immobilization (type 1 CRPS) . Although the pathophysiology of CRPS pain is not clear, it probably results from peripheral and central nervous system sensitization, autonomic dysfunction and inflammatory changes . The development of central sensitization may lead to hypersensitivity, including allodynia, hyperalgesia and persistent pain, which can result in amplification of neural signalling by neural plasticity .…”

“…14 Although the pathophysiology of CRPS pain is not clear, it probably results from peripheral and central nervous system sensitization, autonomic dysfunction and inflammatory changes. 14,15 The development of central sensitization may lead to hypersensitivity, including allodynia, hyperalgesia and persistent pain, which can result in amplification of neural signalling by neural plasticity. 16 Increased activity of N-methyl-D-aspartate receptors and phosphorylation of extracellular signal-regulated kinases contribute to central sensitization.…”

Diagnosis of Complex Regional Pain Syndrome I Following Traumatic Axonal Injury of the Corticospinal Tract in a Patient with Mild Traumatic Brain Injury

“…Therefore, the decreased FN in the left CST appeared to indicate traumatic axonal injury of this neural tract [14,15]. Brain injury is a precipitating factor of CRPS I [7,[16][17][18][19]. The patient's DTT revealed partial tearing of both CSTs, indicating traumatic axonal injury of the CST [14,15].…”