Management Of Complex Regional Pain Syndrome Research Articles

Complex regional pain syndrome: diagnostic challenges and favorable response to prednisolone

Complex regional pain syndrome (CRPS), characterized by severe and disproportionate pain, is a rare and debilitating condition. Due to its rarity, evidence-based treatment guidelines remain limited, creating a challenge for clinicians. We present the case of a 20-year-old female with CRPS type 1 of the right hand. Her pain, initially triggered by a minor trauma, had persisted for three months. The patient demonstrated severe pain, swelling, hyperesthesia, and restricted range of motion. Despite multiple hospital visits, her symptoms did not improve until she was diagnosed with CRPS and treated with oral prednisolone. A dosage of 40 mg daily led to a dramatic response within 10 days. Our report emphasizes the importance of recognizing CRPS and highlights the potential of prednisolone as a treatment option, particularly in resource-limited settings, where more specialized interventions may be unavailable. Further research is essential to establish a stronger evidence base for the use of steroids in CRPS management.

Efficacy of Rehabilitative Intervention on Pain and Function in Patients With Upper Limb Complex Regional Pain Syndrome

Aim: Investigate the efficacy of physical therapy in the management of complex regional pain syndrome (CRPS) Methods: We conducted a systematic review on 3 databases: MEDLINE, EMBASE, and CENTRAL. The applied methods are stated in the protocol and registered in OSF: 10.17605/OSF.IO/SF49B. Results: At the end of the screening process, 12 RCTs were included. Included studies presented heterogeneous and multicomponent interventions. Physical therapy interventions resulted valuable in the management of CRPS. Motor imagery and some physical agents therapies are effective in reducing pain and for functional improvements. Conclusion: Physiotherapy is a central treatment for patients with CRPS.

Complex regional pain syndrome as acause of acute painful limb swelling – acase report

Complex regional pain syndrome (CRPS) is a complex condition characterised by severe pain and various sensory and motor abnormalities. This case report is of an 18-year-old woman presenting with painful upper limb swelling for a few days, with skin mottling and dysesthesia, with significant disability. With negative investigations, a diagnosis of CRPS was made. The case emphasises the importance of early recognition and appropriate management of CRPS, as delayed diagnosis leads to poor quality of life and functional impairment. Healthcare professionals should maintain a high index of suspicion for CRPS in patients with unexplained limb pain and associated sensory and motor abnormalities, ensuring a comprehensive multidisciplinary approach to optimise patients' quality of life.

Interventions for treating pain and disability in adults with complex regional pain syndrome- an overview of systematic reviews.

Complex regional pain syndrome (CRPS) is a chronic pain condition that usually occurs in a limb following trauma or surgery. It is characterised by persisting pain that is disproportionate in magnitude or duration to the typical course of pain after similar injury. There is currently no consensus regarding the optimal management of CRPS, although a broad range of interventions have been described and are commonly used. This is the first update of the original Cochrane review published in Issue 4, 2013. To summarise the evidence from Cochrane and non-Cochrane systematic reviews of the efficacy, effectiveness, and safety of any intervention used to reduce pain, disability, or both, in adults with CRPS. We identified Cochrane reviews and non-Cochrane reviews through a systematic search of Ovid MEDLINE, Ovid Embase, Cochrane Database of Systematic Reviews, CINAHL, PEDro, LILACS and Epistemonikos from inception to October 2022, with no language restrictions. We included systematic reviews of randomised controlled trials that included adults (≥18 years) diagnosed with CRPS, using any diagnostic criteria. Two overview authors independently assessed eligibility, extracted data, and assessed the quality of the reviews and certainty of the evidence using the AMSTAR 2 and GRADE tools respectively. We extracted data for the primary outcomes pain, disability and adverse events, and the secondary outcomes quality of life, emotional well-being, and participants' ratings of satisfaction or improvement with treatment. MAIN RESULTS: We included six Cochrane and 13 non-Cochrane systematic reviews in the previous version of this overview and five Cochrane and 12 non-Cochrane reviews in the current version. Using the AMSTAR 2 tool, we judged Cochrane reviews to have higher methodological quality than non-Cochrane reviews. The studies in the included reviews were typically small and mostly at high risk of bias or of low methodological quality. We found no high-certainty evidence for any comparison. There was low-certainty evidence that bisphosphonates may reduce pain intensity post-intervention (standardised mean difference (SMD) -2.6, 95% confidence interval (CI) -1.8 to -3.4, P = 0.001; I2 = 81%; 4 trials, n = 181) and moderate-certainty evidence that they are probably associated with increased adverse events of any nature (risk ratio (RR) 2.10, 95% CI 1.27 to 3.47; number needed to treat for an additional harmful outcome (NNTH) 4.6, 95% CI 2.4 to 168.0; 4 trials, n = 181). There was moderate-certainty evidence that lidocaine local anaesthetic sympathetic blockade probably does not reduce pain intensity compared with placebo, and low-certainty evidence that it may not reduce pain intensity compared with ultrasound of the stellate ganglion. No effect size was reported for either comparison. There was low-certainty evidence that topical dimethyl sulfoxide may not reduce pain intensity compared with oral N-acetylcysteine, but no effect size was reported. There was low-certainty evidence that continuous bupivacaine brachial plexus block may reduce pain intensity compared with continuous bupivacaine stellate ganglion block, but no effect size was reported. For a wide range of other commonly used interventions, the certainty in the evidence was very low and provides insufficient evidence to either support or refute their use. Comparisons with low- and very low-certainty evidence should be treated with substantial caution. We did not identify any RCT evidence for routinely used pharmacological interventions for CRPS such as tricyclic antidepressants or opioids. Despite a considerable increase in included evidence compared with the previous version of this overview, we identified no high-certainty evidence for the effectiveness of any therapy for CRPS. Until larger, high-quality trials are undertaken, formulating an evidence-based approach to managing CRPS will remain difficult. Currentnon-Cochrane systematic reviews of interventions for CRPS are of low methodological quality and should not be relied upon to provide an accurate and comprehensive summary of the evidence.

1. Treatment of Complex Regional Pain Syndrome of the Knee With Peripheral Nerve Stimulation After Failed Dorsal Root Ganglion Stimulation

BACKGROUND: Complex regional pain syndrome (CRPS) is a chronic progressive neuropathic condition that generally presents following trauma, surgical procedures, or develop spontaneously. Clinical recommendations are to pursue early, multifactorial treatment modalities, such as physical therapy, psychotherapy, along with medications. If conservative treatment becomes insufficient, interventional treatments, such as dorsal root ganglion (DRG) stimulation and peripheral nerve stimulation (PNS), have been proven effective measures in treating the condition. CASE REPORT: A 44-year-old woman, who underwent multiple knee surgeries originally for osteoarthritis, developed CRPS Type II around her right knee. A L3/L4 DRG stimulator was implanted after conservative treatment failed. She reported 50% improvement and reduced opioid requirement. Symptoms returned due to a L3 DRG lead fracture with an attempted revision. However, postsurgical complications developed: neuroforaminal scarring, which precluded lead replacement and resulted in explantation. A PNS implant was pursued with reported 75% to 80% symptom relief, titration off all medications, and significant return of function. CONCLUSIONS: This case highlights PNS in treating advanced CRPS either as the initial neurostimulator of choice in select populations or as an effective alternative in the event that DRG stimulation or spinal cord stimulation proves ineffective or unfeasible. Here, our patient illustrated favorable results with PNS vs DRG in her CRPS management allowing her to regain her ability to function independently of constant pain and opioids. KEY WORDS: Complex regional pain syndrome, dorsal root ganglion stimulation, peripheral nerve stimulation, case report

Clinical practice guidelines for the management of patients with complex regional pain syndrome: a systematic appraisal using the AGREE II instrument.

Aim: Complex regional pain syndrome (CRPS) is a debilitating, painful condition of limbs that often arises after an injury and is associated with significant morbidity. Materials & methods: The Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument, used to assess the quality of clinical practice guidelines (CPGs), was used to evaluate sevenCRPS management guideline. Results: Out of the sevenCPGs evaluated using the AGREE II instrument, only one from Royal College of Physicians was found to have high-quality consensus guidelines for diagnosis and management of CRPS. Conclusion: Future CPGs should be backed by systematic literature searches, focus on guidelines clinical translation into clinical practice and applicability to the desired patient population.

Effectiveness of Decision Support to Treat Complex Regional Pain Syndrome

Background: Complex regional pain syndrome (CRPS) type 1 is a rare but disabling pain condition, usually involving distal extremities such as the wrist, hand, ankle, and foot due to either direct or indirect traumas. CRPS type 1 is characterized by a complex set of symptoms where no correlation can be identified between the severity of the initial injury and the ensuing painful syndrome. Over the years, numerous treatment strategies have been proposed for CRPS management, but therapies remain controversial. At present, no successful therapeutic intervention exists for this condition. The aim of the present study was to propose and assess the effectiveness of a rehabilitative treatment algorithm for CRPS, which is actually in use at our institution. Methods: We retrospectively reviewed all the patients that underwent physical rehabilitative treatment algorithm for hand CRPS between 2011 and 2017 at our Institution. Results: All the parameters taken into consideration, namely the Purdue Pegboard Test (PPT), Disability of the Arm, Shoulder and Hand (DASH), Visual Analog Scale (VAS), as well hand edema, were significantly improved at the end of the rehabilitation protocol. Conclusions: The results obtained in the present study demonstrated that our rehabilitation protocol was able to achieve substantial improvement in pain and quality of life scores. Thus, an early and skillful rehabilitation intervention is of paramount importance for CPRS type 1 management to achieve a stable and optimal functional recovery while preventing the onset of deformities.

A guide to complex regional pain syndrome for the trauma and orthopaedic surgeon

Complex regional pain syndrome (CRPS) is a chronic neurological condition characterized by spontaneous regional pain usually affecting an extremity, with autonomic and inflammatory features. It is a relatively uncommon and many cases resolve within the first year, with only a small proportion progressing to chronic CRPS. Multiple pathophysiological mechanisms are involved, including prolonged inflammation, autonomic dysfunction and neuroplasticity. The effective management of CRPS is challenging and involves a multidisciplinary approach including physical therapy, medications, surgical options and spinal stimulation.

Effectiveness of Peripheral Median, Radial, and Ulnar Nerve Block at Wrist along with Intra-Articular Steroid Injection in Shoulder Joint in Management of Complex Regional Pain Syndrome of Upper Limb: 1-Week Follow-Up Study.

Complex regional pain syndrome (CRPS) of upper limbs is one of the under-recognized painful disabling condition seen in many neurological conditions. To see the effectiveness of peripheral nerve blocks (PNB) along with intra-articular injection in shoulder joint in the improvement of pain, swelling and range of motion (ROM) of the upper limb in CRPS. It was a single-center, prospective study in male and female patients between 18 and 70 years with CRPS of the upper limb due to any etiology, within one year of illness. Single-dose of the intra-articular shoulder joint injection and peripheral nerve blocks at the wrist with steroid, 2% lignocaine, and sterile water was given. The primary outcome measure was a reduction in pain in the upper limb, assessed with a visual analog scale (VAS). Secondary outcome measures were an improvement in passive ROM of joints and a decrease in swelling of the hand. The significance of the P value was adjudged against an alpha of 0.05. Thirty-three patients (25 men), with a mean (SD) age of 55.2 (9.4) years, and mean (SD) duration of illness of 101.9 (76.8) days were included. After 1 week, there was a significant improvement (P < 0.05) in the ROM of joints. The decrease in pain scores on VAS [mean difference -5.1 (CI -5.7, -4.5)] and reduction in hand swelling [mean difference -0.9 (CI -1.1, -0.7)] was also significant. Peripheral median, radial, and ulnar nerve block at wrist along with intra-articular steroid injection in the shoulder joint is an effective method of management of CRPS of the upper limb.

Complex regional pain syndrome associated with henoch-schonlein purpura: A rare occurrence

Introduction: Henochschonlein purpura (HSP) is an acute, systemic, immune complex-mediated, leukocytoclastic vasculitis, most commonly affecting children. It is a small-vessel vasculitis which is characterized by a tetrad of palpable purpura (without thrombocytopenia), abdominal pain, arthritis, and renal impairment. Although most commonly affecting the skin, joints, gastrointestinal tract, and kidneys, other organs may also be affected. Association of HSP with complex regional pain syndrome (CRPS) has not been reported in the literature. In the present case report, we are describing the successful management of CRPS of the upper limb in a diagnosed case of HSP. Case Presentation: A 14-year-old female patient, who was a diagnosed case of HSP, presented with features characteristic of CRPS in the right hand and forearm, based on the Budapest Diagnostic Criteria. Bone scintigraphy showed increased tracer uptake in joints of the right hand, also suggestive of CRPS. The pain was severe visual analog scale-90/100 and not controlled with conservative management. Patient was administered a series of 3 stellate ganglion minimally invasive pain and spine interventions (MIPSI) over the course of 2 weeks, which led to the resolution of her symptoms. Conclusion: HSP is a small-vessel vasculitis and may lead to peripheral nerve vasculitis. As reported in other cases, small-vessel vasculitis has led to the development of CRPS and thus may influence the development of CRPS in patients with HSP. CRPS as a complication of HSP has not been reported in the literature to date. Thus in a patient with HSP, CRPS could present as a rare complication and early intervention with the MIPSI of the affected region may lead to resolution of symptoms.

Exploring the impact of pain management programme attendance on complex regional pain syndrome (CRPS) patients' decision making regarding immunosuppressant treatment to manage their chronic pain condition.

Objectives Complex regional pain syndrome (CRPS) is a rare chronic pain condition for which no curative treatment exists. Patients in tertiary centres are often required to make decisions about treatment options. This study was conducted to explore how prior attendance of a pain management program might alter patients' decision making processes. Methods This qualitative study uses focus groups to gather patient views on an immunosuppressant drug treatment (mycophenolate) for the management of CRPS. Participants were allocated to one of three focus groups based on their treatment journey; Group 1 (n=3) were involved in a recent mycophenolate drug trial; Group 2 (n=5) were neither involved in the trial nor attended a Pain Management Programme (PMP); Group 3 (n=6) were not involved in the trial but had attended a PMP. Outcomes were considered within the framework of Leventhal's Common Sense Model (CSM) in relation to the decision making process. Results Thematic analysis identified differing themes for each group. Group 1: (1) Medication as a positive form of treatment, (2) The trial/drug and (3) Pacing. Group 2: (1) Medication as form of treatment, (2) Other forms of support/treatment and (3) Side effects of mycophenolate. Group 3: (1) Varied view of medication, (2) Consideration of other forms of support and (3) Side effects. Conclusions Attendance on a PMP might provide patients with skills to better manage uncertainty when faced with various treatment options. Leventhal's model goes some way to explaining this. The specific importance of, and benefit from understanding pacing when commencing an effective drug treatment for chronic pain became apparent.

Understanding the Rehabilitation Needs of Korean Patients With Complex Regional Pain Syndrome

ObjectiveTo evaluate the current status of pain severity and quality of life (QoL) in patients with complex regional pain syndrome (CRPS), and to assess both their perceived needs and any unmet needs of current rehabilitation services.MethodsA single-center questionnaire-based survey was conducted on 47 patients with CRPS who were diagnosed based on Budapest’s criteria. It collected demographic and clinical data, and the structured questionnaire included the Brief Pain Inventory (BPI), the Korean version of the World Health Organization Disability Assessment Schedule II (WHODAS-K II), as well as the 5-Level EuroQol-5D (EQ-5D-5L) for measuring the QoL.ResultsThe average value of BPI and WHODAS-K II were 7.69%±2.26% and 70.49%±19.22%, respectively. In the evaluation of their perceived needs and unmet needs for rehabilitation, patients had the highest rehabilitation needs in terms of pain (95.74%), followed by bodyaches (80.85%). Regarding their unmet needs, patients had the highest unmet needs in terms of memory impairment (83.33%), followed by weight management (72.00%). According to the regression analysis, only the overall BPI was significantly associated with QoL (p=0.01), and a higher BPI value led to poorer results for QoL.ConclusionIn Korea, patients with CRPS do not receive adequate rehabilitation, and they are not satisfied with current received treatments. A more structured and individualized rehabilitation treatment plan is required to manage every aspect related to chronic pain, and provision should be made for improved care guidelines for future CRPS management.

Effectiveness of Physical Therapy Plus TIOBEC® (α-Lipoic Acid + Vitamin B, C, and E) on Complex Regional Pain Syndrome (CRPS): A Small Case Series/Pilot Study

Background: Complex regional pain syndrome (CRPS) is a frequent and devastating complication that occurs after trauma and immobilization and is very frequent after wrist fractures (1% - 37%) and after volar locking plate fixation (3% - 10%). The development of CRPS considerably lengthens the time of recovery after a traumatic injury, causing a great impact on work, social activities and psychological well-being. Objectives: To demonstrate the efficacy of physical therapy and TIOBEC® (a combination of α-lipoic acid and vitamin B, C, and E) in terms of pain amelioration and edema reduction in the management of CRPS in a small series of patients. Methods: Prospective before-and-after study. The protocol of treatment included physical therapy (electromagnetic fields applied to the symptomatic limb [20 Hz-50 Gauss-20 min] followed by manual therapy [assisted, active and resisted mobilization plus manual drainage]) plus oral medication (TIOBEC® 400 mg) prescribed twice a day. Components of TIOBEC® included α-lipoic acid (800 mg), vitamin C (60 mg), niacin (36 mg), vitamin E (10 mg), vitamin B1 (25 mg), vitamin B2 (25 mg), vitamin B6 (9.5 mg), vitamin B12 (25 µg) and folic acid (400 µg). Outcome measures included VAS (visual analog scale) pain scale, reduction of edema at the metacarpal phalangeal joint (hand/foot) and functional evaluation (by Kapandji score) before-and-after treatment. Outcome measures were evaluated at baseline and at mid-term (4 months follow-up period). Results: Five patients (mean [SD] age: 61 [7.9]) who had been diagnosed clinically by neurophysiological sympathetic skin-response, gammagraphy, and radiography were recruited in the study. Mean electrotherapy and manual therapy sessions were 40 ± 27.83. Mean oral medication (TIOBEC®) was 84 ± 13.41 days. Physical therapy and TIOBEC® decreased pain from 6.6 ± 0.54 to 2.8 ± 1.3 (P = 0.001), decreased edema from 12 ± 5.7 mm to 4 ± 4.18 mm (P = 0.035) and improved functional Kapandji score from 6.2 ± 2.77 to 9.4 ± 1.34 (P = 0.029). Neither of the patients stopped oral medication nor reported adverse events. Conclusions: The protocol that includes the electromagnetic field, manual therapy, and TIOBEC® may be safely used in patients with CRPS in an attempt to ameliorate pain, to reduce edema and to improve function. In light of the results of this study, the protocol used might accelerate recovery time. More studies are needed to corroborate the present results observed in this pilot study.

Complex regional pain syndrome: An updated comprehensive review.

Complex regional pain syndrome (CRPS) is a complex disorder that can have a significant impact on the quality of life of a person with this syndrome. The diagnosis and treatment of CRPS are often difficult as there is no one confirmatory test and no one definitive treatment. Currently, the most widely accepted clinical diagnostic criteria are the Budapest criteria, which were developed by expert consensus. Though no one single treatment has been found to be universally effective, early detection and an interdisciplinary approach to treatment appear to be key in treating CRPS. This review aims to present up-to-date clinical information regarding the diagnosis and management of CRPS and highlight the potential issues with diagnosis in the neurological population. Ultimately, more research is needed to identify the exact etiology of CRPS in order to help target appropriate therapies. In addition, more randomized controlled trials need to be performed in order to test new therapies or combinations of therapies, including pharmacological, interventional, and behavioral therapies, to determine the best treatment options for this potentially debilitating disorder.

Sex matters in complex regional pain syndrome.

BackgroundComplex regional pain syndrome (CRPS) is much more prevalent in women than men but potential differences in clinical phenotype have not been thoroughly explored to date. Differences in the clinical presentation between sexes may point at new avenues for a more tailored management approach of CRPS. We therefore explored if in CRPS, the patient's sex is associated with differences in clinical and psychological characteristics.MethodsIn this cross‐sectional study of 698 CRPS patients (599 females) fulfilling the Budapest clinical or research criteria, CRPS signs and symptoms, CRPS severity, pain (average pain intensity in the previous week and McGill pain rating index), pain coping (Pain Coping Inventory), physical limitations (Radboud Skills Questionnaire (upper limb), Walking and Rising questionnaire (lower limb)), anxiety and depression (Hospital Anxiety and Depression scale) and kinesiophobia (Tampa scale for kinesiophobia) were evaluated.ResultsMale CRPS patients used more often extreme words to describe the affective qualities of pain, used more passive pain coping strategies, and were more likely to suffer from depression and kinesiophobia.ConclusionSex‐related differences are present in CRPS, but the effect is generally small and mainly concerns psychological functioning. A greater awareness of sex‐specific factors in the management of CRPS may contribute to achieving better outcomes.SignificanceWhat is known? Nonsex‐specific clinical data of CRPS patients. What is new? Male CRPS patients used more often extreme words to describe the affective qualities of pain, used more passive pain coping strategies, and were more likely to suffer from depression and kinesiophobia.

Updates in Complex Regional Pain Syndrome

Background: The Complex Regional Pain Syndrome (CRPS), known as reflex sympathetic dystrophy, Sudeck atrophy, causalgy or posttraumatic pain has been described as an important cause of chronic morbidity, which acknowledge of clinical limits, pathophysiology and implications of pathogenesis is still little elucidated. Therefore a great dissatisfaction for patients and health professionals has been described regarding to the currently available therapeutic methods. Objectives: The goal of this paper is to discuss the current perspectives of physiopathology, diagnosis and treatment in CRPS. Methods: A review of the literature was carried out using the MEDLINE, LILACS, and SciELO databases, with preference to articles in English, Portuguese and Spanish. Results: The diagnosis is predominantly based in clinical evidences of signs and symptoms. Although it has been described in the literature in many studies and guidelines about the treatment of CRPS, there is no consensus of procedure indications. Between the surgical methods, the use of spinal cord stimulation and others neuromodulators approaches has been described associated to significant rates of success in the management of CRPS. Conclusion: According to the literature and authors experience, the successful treatment of CRPS is based in early diagnosis associated to experienced interdisciplinary team aiming the functional restoration and psychological aspect monitoring.

Management of complex regional pain syndrome of the hand

Downloadable open access UK guidelines for managing complex regional pain syndrome (CRPS) have been available since 2012. Care is interdisciplinary and readers involved in the care of patients with CRPS are strongly recommended to read these guidelines. Since 2012 there have been several larger randomized controlled trials (RCTs) which have helped to clarify the role of some treatments in CRPS management, although the results of some subsequent meta-analyses have been conflicting. Early data from an RCT with 152 patients suggest superiority of dorsal root ganglion stimulation over conventional spinal cord stimulation in patients with lower extremity CRPS. An RCT involving 111 patients investigating the role of low-dose intravenous immunoglobulin treatment in long-standing CRPS failed to show benefit from this treatment. Despite the lack of direct evidence that nociceptive and neuropathic pain drugs can relieve pain from CRPS, it is reasonable for orthopaedic surgeons to follow relevant guidelines and initiate treatment with these drugs and to request GP colleagues to monitor and titrate these drugs as appropriate. As per the UK CRPS guidelines, the non-surgical approach to the management of CRPS centres on the following four pillars of care: education, physical rehabilitation, pain relief and psychological intervention where appropriate.

A proposed clinical conceptual model for the physiotherapy management of Complex Regional Pain Syndrome (CRPS)

There are no validated clinical models to show a reliable pathway of guaranteeing an effective recovery for Complex Regional Pain Syndrome (CRPS) with physiotherapy management. An array of medical, psychological and physiotherapy intervention methods show weak benefit. Spearman correlations, with significance p < 0.05, from an observational, prospective, longitudinal, multi-centre study of regional standard physiotherapy CRPS management showed complete recovery to be potentially associated with baseline factors of: better mental health; better functional ability and quality of life; higher scores of extraversion personality trait; lower scores of intraversion personality trait; and interventions such as concurrent prescription of the anticonvulsant secondary analgesia group and a higher intensity of physiotherapy education intervention. These correlations were integrated with the literature evidence and the crux of previously suggested models to conceptualise a clinical model that can contribute to the broader knowledge of physiotherapy management in CRPS that should be tested with future research.

Complex Regional Pain Syndrome Type 1: Diagnosis and Management.

Diagnosis of Complex regional pain syndrome (CRPS) is made primarily on a clinical basis, and no specific test is known to confirm or exclude CRPS diagnosis. That is, there aren't specific diagnostic tools and instrumental tests are made only for identifying an etiology at the basis of the CRPS. Numerous therapeutic methods have been introduced, but none have shown definitive results. When symptoms persist, patients experience permanent impairment and disability. Therefore, early recognition of CRPS, along with proper treatment, is important for minimizing permanent loss of function. As there is no gold standard test for CRPS, several clinical diagnostic criteria have been introduced and applied in various studies. However, to date, no formal or standardized diagnostic criteria for CRPS have been widely accepted. However, the Budapest diagnostic criteria have recently increased in popularity and are frequently used in scientific studies. The goal for management of CRPS is the return of normal limb function. No specific technique has been shown to prevent CRPS following surgery, but avoidance of prolonged immobilization may be important. Therefore, initiating early post-surgical rehabilitation, where possible, is important. A multidisciplinary approach would seem to be optimal, above all things objectives of physical and occupational therapy are fulfilled with combination pharmacotherapy due to provide pain relief to facilitate physical rehabilitation. Future research using large randomized controlled trials should focus on collecting strong evidence for the etiology of CRPS, testing pharmacological effects, and determining appropriate combination treatment strategies.

Pharmacological and Non-pharmacological Treatment for Complex Regional Pain Syndrome (CRPS): A Review

Complex regional pain syndrome (CRPS), previously known as reflex sympathetic dystrophy (RSD) or causalgia, is a chronic debilitating neurological disorder characterized by limb pain, that can be developed after a minor trauma, fractures or lesions of the peripheral or central nervous system. The prevalence of CRPS is relatively low; and the symptoms of this dynamic disease are distinct among different patients. No specific diagnostic test is available and hence diagnosis is mainly relied on clinical examination and supportive laboratory findings. Also, since the symptoms are individual-specific, there exist no single drug which is effective globally among the patient community. An early recognition, prompt initiation and a multidisciplinary approach including pharmacological, rehabilitation and psychological therapies seems to be effective in treating CRPS, to obtain an optimum outcome. This review encompasses recent advances in the treatment strategies – medical and non-medical – employed in the management of CRPS.