Chapter 35 Complex regional pain syndrome

Abstract

Publisher Summary This chapter describes complex regional pain syndrome (CRPS) as changes of muscles and bones distant from the primary tissue damage. It causes both acute pain and excitation of the sympathetic nervous system. The chapter classifies CRPS into two clinical types: the “primarily warm” type, which usually develops post-traumatically and in which skin temperature is increased on the affected side; and CRPS cases, which manifest with a cold skin from the beginning. This “primarily cold” type more often develops after minor trauma or even spontaneously. The chapter reviews that “primary cold” CRPS is harder to treat and tends to become chronic. Symptoms of CRPS are not stable; they change and evolve from acute to chronic CRPS stages. In primarily warm CRPS skin temperature becomes cold, edema dwindles, and a trophic sign like increased hair and nail growth normalizes with progression. Cold CRPS, in contrast, appears much more stable. Skin color remains bluish, edema and trophic changes are often less present, and skin temperature may remain cold for years. Nevertheless, sensory and motor symptoms also change in chronic cases. The chapter discusses that treatment of CRPS must have two aims: to relieve pain and hyperalgesia, and to maintain or return function of the affected extremity. To achieve this, treatment has to start as soon as possible.