JOURNAL ARTICLE
REVIEW

The complex regional pain syndrome

Anne Louise Oaklander, Steven H Horowitz
Handbook of Clinical Neurology 2015, 131: 481-503
26563805
Complex regional pain syndrome (CRPS) is the current consensus-derived name for a syndrome usually triggered by limb trauma. Required elements include prolonged, disproportionate distal-limb pain and microvascular dysregulation (e.g., edema or color changes) or altered sweating. CRPS-II (formerly "causalgia") describes patients with identified nerve injuries. CRPS-I (formerly "reflex sympathetic dystrophy") describes most patients who lack evidence of specific nerve injuries. Diagnosis is clinical and the pathophysiology involves combinations of small-fiber axonopathy, microvasculopathy, inflammation, and brain plasticity/sensitization. Females have much higher risk and workplace accidents are a well-recognized cause. Inflammation and dysimmunity, perhaps facilitated by injury to the blood-nerve barrier, may contribute. Most patients, particularly the young, recover gradually, but treatment can speed healing. Evidence of efficacy is strongest for rehabilitation therapies (e.g., graded-motor imagery), neuropathic pain medications, and electric stimulation of the spinal cord, injured nerve, or motor cortex. Investigational treatments include ketamine, botulinum toxin, immunoglobulins, and transcranial neuromodulation. Nonrecovering patients should be re-evaluated for neurosurgically treatable causal lesions (nerve entrapment, impingement, infections, or tumors) and treatable potentiating medical conditions, including polyneuropathy and circulatory insufficiency. Earlier impressions that CRPS represents malingering or psychosomatic illness have been replaced by evidence that CRPS is a rare complication of limb injury in biologically susceptible individuals.

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Edwin Barron Jr

I have had CRPS1. See CRPS a possible cure. Edwin N Barron MD . Sequential sural nerve blocks have produced dramatic relief in my case . Following the third block there as a sequential " snapping rubber bands " sensation in four tendons of my left foot as well as marked relief of pain peripherally in both thighs and left leg . This is anecdotal . It does offer insight for investigation . Please see my Web page . CRPS complex regional pain syndrome , A quick relief and possible cure .

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