4.2 Review

Complex Regional Pain Syndrome: Evidence-Based Advances in Concepts and Treatments

Journal

CURRENT PAIN AND HEADACHE REPORTS
Volume 27, Issue 9, Pages 269-298

Publisher

SPRINGER
DOI: 10.1007/s11916-023-01130-5

Keywords

Complex regional pain syndrome; CRPS I; CRPS II; Neuropathic pain; Nociplastic pain; Reflex sympathetic dystrophy; Chronic pain; Acute pain; Neuromodulation; Ketamine; Spinal cord stimulation; DRG stimulation

Ask authors/readers for more resources

This review presents the most current information about the epidemiology, classification, diagnostic criteria, pathophysiology, treatments, and preventive strategies of complex regional pain syndrome (CRPS).
Purpose of ReviewThis review presents the most current information about the epidemiology of complex regional pain syndrome (CRPS), classification and diagnostic criteria, childhood CRPS, subtypes, pathophysiology, conventional and less conventional treatments, and preventive strategies.Recent FindingsCRPS is a painful disorder with multifactorial pathophysiology. The data describe sensitization of the central and peripheral nervous systems, inflammation, possible genetic factors, sympatho-afferent coupling, autoimmunity, and mental health factors as contributors to the syndrome. In addition to conventional subtypes (type I and type II), cluster analyses have uncovered other proposed subtypes. Prevalence of CRPS is approximately 1.2%, female gender is consistently associated with a higher risk of development, and substantial physical, emotional, and financial costs can result from the syndrome. Children with CRPS seem to benefit from multifaceted physical therapy leading to a high percentage of symptom-free patients. The best available evidence along with standard clinical practice supports pharmacological agents, physical and occupational therapy, sympathetic blocks for engaging physical restoration, steroids for acute CRPS, neuromodulation, ketamine, and intrathecal baclofen as therapeutic approaches. There are many emerging treatments that can be considered as a part of individualized, patient-centered care. Vitamin C may be preventive.CRPS can lead to progressively painful sensory and vascular changes, edema, limb weakness, and trophic disturbances, all of which substantially erode healthy living. Despite some progress in research, more comprehensive basic science investigation is needed to clarify the molecular mechanisms of the disease so that targeted treatments can be developed for better outcomes. Incorporating a variety of standard therapies with different modes of action may offer the most effective analgesia. Introducing less conventional approaches may also be helpful when traditional treatments fail to provide sufficient improvement.

Authors

I am an author on this paper
Click your name to claim this paper and add it to your profile.

Reviews

Primary Rating

4.2
Not enough ratings

Secondary Ratings

Novelty
-
Significance
-
Scientific rigor
-
Rate this paper

Recommended

No Data Available
No Data Available