Complex Regional Pain Syndrome: Updates and Current Evidence

Abstract

Purpose of Review Complex regional pain syndrome (CRPS) is a debilitating condition that manifests with sensory, neurologic, autonomic, and/or trophic impairment. In addition to manifesting with severe neuropathic pain, CRPS is associated with poor quality of life and higher annual healthcare costs. This systematic review appraises the current body of evidence on all treatment modalities for CRPS. Recent Findings In patients with CRPS-related pain, there is level I evidence supporting modest to moderate improvement in pain intensity from physical therapy, occupational therapy, massage therapy, acupuncture, and transcutaneous electrical nerve stimulation (TENS), although changes in functionality were inconsistent. Topical medications such as eutectic mixture of local anesthetic (EMLA) and ketamine cream were associated with decreased allodynia and hyperalgesia. Inconsistency was present in the current literature in terms of the analgesic effects of gabapentinoids for CRPS. Patients who received intramuscular or intravenous bisphosphonate therapy may achieve modest to moderate improvement in pain intensity and functionality. Systemic steroid and ketamine provided only short-term pain reduction. In terms of interventional therapy, there was an association of modest to moderate improvement in pain with sympathetic ganglion block, sympathectomy, dorsal column spinal cord stimulation, dorsal root ganglion stimulation, and peripheral nerve stimulation, although the level of evidence was limited. Summary In summary, the purpose of this systematic review is to equip the clinician with important updates on conservative, pharmacologic, and interventional treatment modalities for CRPS-related pain.