Complex Regional Pain Syndrome Type 1: Diagnosis and Management

2018 ◽  
Vol 23 (01) ◽  
pp. 1-10 ◽  
Author(s):  
Jae Won Lee ◽  
Sang Ki Lee ◽  
Won Sik Choy

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.

Pain Medicine ◽  
2007 ◽  
Vol 8 (4) ◽  
pp. 326-331 ◽  
Author(s):  
R. Norman Harden ◽  
Stephen Bruehl ◽  
Michael Stanton-Hicks ◽  
Peter R. Wilson

Pain ◽  
1999 ◽  
Vol 83 (2) ◽  
pp. 211-219 ◽  
Author(s):  
Norman R. Harden ◽  
Stephen Bruehl ◽  
Bradley S. Galer ◽  
Samuel Saltz ◽  
Martin Bertram ◽  
...  

Pain ◽  
2010 ◽  
Vol 150 (2) ◽  
pp. 268-274 ◽  
Author(s):  
Norman R. Harden ◽  
Stephen Bruehl ◽  
Roberto S.G.M. Perez ◽  
Frank Birklein ◽  
Johan Marinus ◽  
...  

2008 ◽  
Vol 3;11 (5;3) ◽  
pp. 339-342
Author(s):  
Paul E. Schulz

In this case report, we describe the effect of ketamine infusion in a case of severe refractory complex regional pain syndrome I (CRPS I). The patient was initially diagnosed with CRPS I in her right upper extremity. Over the next 6 years, CRPS was consecutively diagnosed in her thoracic region, left upper extremity, and both lower extremities. The severity of her pain, combined with the extensive areas afflicted by CRPS, caused traumatic emotional problems for this patient. Conventional treatments, including anticonvulsants, bisphosphonates, oral steroids and opioids, topical creams, dorsal column spinal cord stimulation, spinal morphine infusion, sympathetic ganglion block, and sympathectomy, failed to provide long-term relief from pain. An N-methyl-d-aspartate (NMDA) antagonist inhibitor, ketamine, was recently suggested to be effective at resolving intractable pain. The patient was then given several infusions of intravenous ketamine. After the third infusion, the edema, discoloration, and temperature of the affected areas normalized. The patient became completely pain-free. At one-year of follow-up, the patient reported that she has not experienced any pain since the last ketamine infusion. Treatment with intravenous ketamine appeared to be effective in completely resolving intractable pain caused by severe refractory CRPS I. Future research on this treatment is needed. Key words: Ketamine, Complex Regional Pain Syndrome (CRPS), treatment


2006 ◽  
Vol 11 (4) ◽  
pp. 4-8
Author(s):  
Robert J. Barth

Abstract A sidebar titled “Rating Impairment for [complex regional pain syndrome] CRPS Type 1” in the March/April issue of The Guides Newsletter states: “Do NOT use the pain chapter to rate CRPS” because there is no well-defined pathophysiologic basis. That conclusion is contradicted by the pain chapter, which lists CRPS among conditions considered ratable, but accompanying text provides no explanation how this determination was made. This article attempts to resolve the conflict between the sidebar in The Guides Newsletter and the pain chapter. The lack of a well-defined pathophysiologic basis for CRPS is the reason for the position stated in the sidebar, and a review of the relevant professional literature confirms this reasoning. Further, the concept of CRPS itself is ambiguous and was intentionally designed to be “general” and “descriptive” and historically has been diagnosed using nonstandardized, idiosyncratic, or incompatible diagnostic systems. The AMA Guides to the Evaluation of Permanent Impairment is self-contradictory regarding diagnostic criteria and terminology (eg, is CRPS-1 synonymous with RSD, causalgia, or neither?). CRPS lacks any well-defined pathophysiology, is highly ambiguous and controversial, involves characteristics that compromise the credibility of any examinee making such a presentation, and is a good example of a condition that should be evaluated using the mental and behavioral disorders chapter.


2021 ◽  
Vol 26 (3) ◽  
pp. 8-13
Author(s):  
Steven D. Feinberg ◽  
Charles N. Brooks ◽  
Christopher R. Brigham

Abstract Complex regional pain syndrome (CRPS) is characterized by chronic spontaneous and/or evoked regional pain disproportionate in severity, distribution, and/or duration to that typically experienced after a similar injury or illness. The pain may also begin without a known precipitant. While various authors have questioned the validity of the diagnosis, physicians will be asked to perform impairment ratings on patients diagnosed with CRPS. Hence, it is important to understand the issues associated with this syndrome; the diagnostic criteria for it, including the need to rule out other diagnoses that may explain the patient's presentation; and how to rate CRPS. The AMA Guides to the Evaluation of Permanent Impairment, Fifth Edition, provides approaches to assessing CRPS impairment that are refined in the Sixth Edition.


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