Complex Regional Pain Syndrome: Practical Diagnostic and Treatment Guidelines, 5th Edition

Abstract

There have been some modest recent advancements in the research of Complex Regional Pain Syndrome, yet the amount and quality of the work in this complicated multifactorial disease remains low (with some notable exceptions; e.g., the recent work on the dorsal root ganglion stimulation). The semi-systematic (though in some cases narrative) approach to review is necessary so that we might treat our patients while waiting for “better research.” This semi-systematic review was conducted by experts in the field, (deliberately) some of whom are promising young researchers supplemented by the experience of “elder statesman” researchers, who all mention the system they have used to examine the literature. What we found is generally low- to medium-quality research with small numbers of subjects; however, there are some recent exceptions to this. The primary reason for this paucity of research is the fact that this is a rare disease, and it is very difficult to acquire a sufficient sample size for statistical significance using traditional statistical approaches. Several larger trials have failed, probably due to using the broad general diagnostic criteria (the “Budapest” criteria) in a multifactorial/multi-mechanism disease. Responsive subsets can often be identified in these larger trials, but not sufficient to achieve statistically significant results in the general diagnostic grouping. This being the case the authors have necessarily included data from less compelling protocols, including trials such as case series and even in some instances case reports/empirical information. In the humanitarian spirit of treating our often desperate patients with this rare syndrome, without great evidence, we must take what data we can find (as in this work) and tailor a treatment regime for each patient.

Explicit Motor Imaging Abilities are Similar in Complex Regional Pain Syndrome, Chronic Limb Pain and Healthy Individuals: a cross sectional study

“…MI training appears to be an effective treatment for improving neuronal excitability or synapse conductance in healthy and pathological individuals 61 and KMI has the same cortical correlate in relation to movement execution 62 . Recommended rehabilitation programs support the use of MI training alone or in combination with other modalities such as GMI (Graded Motor Imagery) 23,25,[63][64][65][66] . MI training appears to activate areas of the brain involved in movement preparation 15,20,61,67 .…”

“…Inclusion criteria were: age above 18, less than 150 minutes of moderate-to-intense physical activity per week, and education until A level of baccalaureate / high school diploma or equivalent. CRPS patients had to have a CRPS diagnosis by validated Budapest criteria 22,34,35…”

“…Movement is impaired early in CPRS and as a part of motor planning. Currently, MI training is a recommended technique and effective therapy in chronic pain and CRPS [22][23][24][25][26] . Therefore, assessment of MI abilities using a simple questionnaire could be an interesting strategy in the clinical management of patients.…”

EMG biofeedback combined with rehabilitation training may be the best physical therapy for improving upper limb motor function and relieving pain in patients with the post-stroke shoulder-hand syndrome: A Bayesian network meta-analysis

“…Consequently, it can only relieve some clinical symptoms but cannot fundamentally control and treat the occurrence and development of SHS ( 12 ). The treatment guidelines ( 13 ) highlight that since pain and limb dysfunction are the main clinical problems associated with SHS, early physical therapy intervention is the basis and first-line choice for SHS treatment. In addition, most experts, even those who use more invasive interventional techniques, agree that effective treatment should emphasize functionally focused interventions, particularly physical therapy that aims at normalizing the function of the affected limb and alleviating problems associated with disuse ( 14 ).…”

Evaluation of Processed Nerve Allograft in Peripheral Nerve Surgery: A Systematic Review and Critical Appraisal

“…This is also crucial for the society in view of health care costs. 5 Restoration of function of the injured nerve can be performed by different surgical techniques, 8,9 where the primary end-to-end nerve suture, possible to be performed in about 80% of the cases, 10,11 requires tension-free repair. 10,12 In complex injuries, with an extensive nerve defect or when the nerve repair is delayed, different techniques are used to bridge the defect.…”