Spreading of complex regional pain syndrome: not a random process

Abstract

Complex regional pain syndrome (CRPS) generally remains restricted to one limb but occasionally may spread to other limbs. Knowledge of the spreading pattern of CRPS may lead to hypotheses about underlying mechanisms but to date little is known about this process. The objective is to study patterns of spread of CRPS from a first to a second limb and the factors associated with this process. One hundred and eighty-five CRPS patients were retrospectively evaluated. Cox’s proportional hazards model was used to evaluate factors that influenced spread of CRPS symptoms. Eighty-nine patients exhibited CRPS in multiple limbs. In 72 patients spread from a first to a second limb occurred showing a contralateral pattern in 49%, ipsilateral pattern in 30% and diagonal pattern in 14%. A trauma preceded the onset in the second limb in 37, 44 and 91%, respectively. The hazard of spread of CRPS increased with the number of limbs affected. Compared to patients with CRPS in one limb, patients with CRPS in multiple limbs were on average 7 years younger and more often had movement disorders. In patients with CRPS in multiple limbs, spontaneous spread of symptoms generally follows a contralateral or ipsilateral pattern whereas diagonal spread is rare and generally preceded by a new trauma. Spread is associated with a younger age at onset and a more severely affected phenotype. We argue that processes in the spinal cord as well as supraspinal changes are responsible for spontaneous spread in CRPS.

The role of peripheral nerve injections in the diagnosis and treatment of CRPS

“…Female gender can be considered a risk factor for CRPS [15,[18][19][20][23][24][25][26] and, since there is a higher incidence in older patients, the postmenopausal status is also related higher incidence of CRPS [14][15][16]21], although this association could be an epiphenomena linked to higher incidence of fractures and others traumas in this population. However, the common factor in many of these risks may be nerve entrapment.…”

Imaging and Clinical Evidence of Sensorimotor Problems in CRPS: Utilizing Novel Treatment Approaches

“…The pattern of spread is initially on a single limb from distal to proximal but in some people CRPS can progress to involve the contralateral or ipsilateral limb/s. A younger age at onset and more severe CRPS are both risk factors for an increased chance of spread, with a contralateral pattern of spread the most common form (Van Rijn et al 2011). …”

Effects of Low-Level Laser Therapy and Interferential Current Therapy in the Treatment of Complex Regional Pain Syndrome

“…The syndrome is characterized by continuous regional pain, which is disproportionate according to duration and intensity, depending on the type of the initial damage (1). It has been observed that the progression of the disease induces spontaneous spread of symptoms along the affected extremity (5). CRPS type I is manifested in cases where pain is not limited to a dermatome or peripheral nerve distribution, while CRPS type II refers to cases where a nerve lesion is present (1,3).…”

“…It is believed that changes in the peripheral and central somatosensory and autonomous nervous system, as well as neurogenic inflammation, lead to the manifestation of CRPS I (3,5,6).…”