Complex Regional Pain Syndrome: State of the Art Update

Abstract

Although the pathophysiology of complex regional pain syndrome (CRPS) is not fully understood, it appears to reflect multiple interacting mechanisms. In addition to altered autonomic function, a role for inflammatory mechanisms and altered somatosensory and motor function in the brain is increasingly suggested. Several possible risk factors for development of CRPS, including genetic factors, have been identified. Few treatments have been proven effective for CRPS in well-designed clinical trials. However, recent work suggests that bisphosphonates may be useful in CRPS management and that the N-methyl-D: -aspartate receptor antagonist ketamine significantly reduces CRPS pain when administered topically or intravenously at subanesthetic dosages. Extended use of ketamine at anesthetic dosages ("ketamine coma") remains a controversial and unproven treatment for CRPS. Spinal cord stimulation may be effective for reducing pain in approximately two thirds of CRPS patients not responding to other treatments, but its efficacy appears to diminish over time.

Clodronate in the management of different musculoskeletal conditions

“…Typically, a single extremity is affected, and the syndrome may develop in the setting of major nerve injury (CRPS type II) or in the absence of such injury (CRPS type I). 61 in at least 10% of cases, it is not possible to identify an event correlated with the disease. in addition to the typical MRI finding of BME, other possible CRPS radiological features are a patchy or diffuse osteoporosis in the painful region and the enhanced radionuclide uptake on bone scintigraphy.…”

Scrambler Therapy®MC‐5A for Complex Regional Pain Syndrome: Case Reports

“…4 The syndrome may develop in the setting of a documented nerve injury (CRPS type II) or in the absence of such damage (CRPS type I). 6,7 Despite this traditional distinction, signs, symptoms, and treatment of these two subtypes of CRPS are very similar. Diagnosis is clinical; Budapest's criteria have been updated and are widely accepted.…”

Children and Adolescents with Complex Regional Pain Syndrome: More Psychologically Distressed than Other Children in Pain?

“…These studies have generally failed to identify significant differences between groups. In addition to a lack of support for a central etiological role of psychological factors in more recent studies, there is also mounting evidence of multiple interacting mechanisms in the pathophysiology of CRPS, including autonomic function changes, altered somatosensory and motor processes, inflammatory mechanisms and possible genetic risk factors (21). Thus, the prevailing view of CRPS has shifted toward one of a multifaceted condition best treated using comprehensive, integrated treatment approaches (9,11).…”