Complex Regional Pain Syndrome Types I and II

Abstract

This report aims to describe complex regional pain syndrome (CRPS) type I and type II. CRPS describes a spectrum of painful conditions that have a common presentation, including pain that is disproportionate to the initiating injury or instigating event. Both CRPS type I and type II have a hallmark of allodynia, severe hyperalgesia, edema and skin changes, and abnormal alterations in sudomotor and vasomotor function. CRPS type I was formally identified as reflex sympathetic dystrophy. CRPS type II is a new term for what was formally described as causalgia. The difference between the two is mainly in the type of inciting event rather than clinical presentation: type I does not include obvious nerve injury, whereas type II CRPS occurs with documented nerve injury. CRPS can occur in both the acute setting and as an exacerbation or change in existing chronic pain. Symptoms of CRPS can occur from a wide range of insults or injuries, such as ankle sprain, bug bite, an operation, or after casting. Similarly, the diagnostic criteria for CRPS type I and type II point to a spectrum of clinical and symptom findings, further emphasizing the varied nature and spectrum of the syndrome. No single standard test is available for its diagnosis. Clinical and exam findings are critical in forming the diagnosis for CRPS type I and type II, and there is a clear pattern of pain that needs to be identified early despite the possibility that all criteria may not have been met for diagnosis. Clinical treatment of patients with CRPS and those that may not fit all criteria for CRPS should emphasize functional restoration, pain abatement using appropriate pharmacological medications and interventional treatment, and psychological therapy. Patients with CRPS need a customized approach to their treatment, and care must be taken to address these needs early to provide the best outcomes. CRPS can progress rapidly if there is a failure in specialized functional restoration and rest therapeutic treatment to help musculoskeletal function.