Complex regional pain syndrome: An updated comprehensive review

2020 ◽  
Vol 47 (3) ◽  
pp. 253-264
Author(s):  
Allison Kessler ◽  
Min Yoo ◽  
Randy Calisoff
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Treatment Options ◽  
Interdisciplinary Approach ◽  
Clinical Information ◽  
Pain Syndrome ◽  
Definitive Treatment ◽  
Confirmatory Test ◽  
Exact Etiology ◽  
Behavioral Therapies ◽  
Budapest Criteria

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.

Validity of the Budapest Criteria For Poststroke Complex Regional Pain Syndrome

2019 ◽  
Vol 35 (10) ◽  
pp. 831-835 ◽  
Author(s):  
Sang-Wook Oh ◽  
Seong-Uk Choi ◽  
Mina Park ◽  
Joon-Ho Shin
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Pain Syndrome ◽  
Budapest Criteria

scholarly journals Complex Regional Pain Syndrome (CRPS/RSD) and Neuropathic Pain: Role of Intravenous Bisphosphonates as Analgesics

2008 ◽  
Vol 8 ◽  
pp. 229-236 ◽  
Author(s):  
Jennifer Yanow ◽  
Marco Pappagallo ◽  
Letha Pillai
Keyword(s):  
Clinical Trials ◽  
Neuropathic Pain ◽  
Animal Models ◽  
Complex Regional Pain Syndrome ◽  
Bone Pain ◽  
Treatment Options ◽  
Pain Syndrome ◽  
Pain Pathways ◽  
Intravenous Bisphosphonates

Neuropathic pain is a sequela of dysfunction, injuries, or diseases of the peripheral and/or central nervous system pain pathways, which has historically been extremely difficult to treat. Complex regional pain syndrome (CRPS) types 1 and 2 are neuropathic pain conditions that have a long history in the medical literature but whose pathophysiology remains elusive and whose available treatment options remain few. While an exact animal model for CRPS doesn't yet exist, there are several animal models of neuropathic pain that develop behaviors of hypersensitivity, one of the hallmark signs of neuropathic pain in humans.Bisphosphonates have been used for pathologic conditions associated with abnormal bone metabolism, such as osteoporosis, Paget’s disease and cancer-related bone pain for many years. More recently, results of clinical trials have indicated the potential role of bisphosphonates in the treatment of CRPS/RSD.In this paper we will review the preclinical studies regarding the use of bisphosphonates as analgesics in animal models of neuropathic pain, and also summarize the clinical trials that have been done to date. We will give an overview of bisphosphonate pharmacology and discuss several potential mechanisms by which bisphosphonates may be analgesic in CRPS/RSD and bone pain of noncancer origin.

scholarly journals Validation of proposed diagnostic criteria (the “Budapest Criteria”) for Complex Regional Pain Syndrome

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

scholarly journals Spinal Cord Stimulation for Complex Regional Pain Syndrome: A Case Study of a Pregnant Female

2016 ◽  
Vol 3;19 (3;3) ◽  
pp. E487-E493
Author(s):  
Shaik Ahmed
Keyword(s):  
Spinal Cord ◽  
Complex Regional Pain Syndrome ◽  
Spinal Cord Stimulation ◽  
Treatment Options ◽  
Pain Syndrome ◽  
Conclusive Evidence ◽  
Treatment Modalities ◽  
Child Bearing ◽  
The Impact

Background: Spinal cord stimulation (SCS) is a form of neuromodulation, used to treat chronic neuropathic pain refractory to conventional medical management. Spinal cord stimulators are treatment options when intractable chronic pain has not responded to more conventional treatment modalities. Currently, the use of SCS is contraindicated in pregnancy. Nevertheless, many SCS/ neuromodulation recipients are women of child bearing age who may become pregnant. There are no published reports that focus on the possible side effects of SCS or neuromodulation therapy on human fertility, fetal development, pregnancy, delivery, or lactation. Objectives: The purpose of this current report is to present a case study on the use of SCS/ neuromodulation during pregnancy. Study Design: Presentation of the case of a 24 year old female who became pregnant after receiving an SCS implantation for pain control secondary to complex regional pain syndrome (CRPS). The SCS was in use at the time of conception but deactivated when patient became aware of her pregnancy and intermittently reactivated for five minute intervals throughout the entire pregnancy. Results: Currently very little documented evidence is available regarding the safety of using a SCS/ neuromodulator during pregnancy; therefore its use during pregnancy is contraindicated. Available literature suggests that, women who have chosen to keep the SCS/neuromodulator activated during pregnancy have delivered healthy babies without any life threatening complications. Limitations: Case presentations do not provide conclusive evidence of treatment effectiveness. This data is only preliminary and future studies should be used to assess outcomes and measures to provide quantification of the SCS implantation during pregnancy. Conclusions: Women of child bearing age who are recipients of SCS/neuromodulation implantation should be informed of the limited knowledge available regarding the impact of SCS/ neuromodulation use during pregnancy. For current recipients, decisions about ongoing use during pregnancy should be an individual decision based on the potential risks and benefits. Key words: Pregnancy and complex regional pain syndrome, pregnancy and reflex sympathetic dystrophy, pregnancy and spinal cord stimulators, pregnancy and electromagnetic fields, and pregnancy and neuromodulator.

scholarly journals Martorell’s ulcer: a literature review and own clinical observation

2021 ◽  
Vol 18 (1) ◽  
pp. 55-70
Author(s):  
B. V. Boldin ◽  
P. Yu. Golosnitskiy ◽  
V. Yu. Bogachev ◽  
S. V. Rodionov ◽  
I. M. Dizengof
Keyword(s):  
Clinical Observation ◽  
Treatment Options ◽  
Local Treatment ◽  
Local Therapy ◽  
Pain Syndrome ◽  
Definitive Treatment ◽  
Outpatient Basis ◽  
Narcotic Analgesics ◽  
Wide Range ◽  
The Right

Introduction. Martorell’s ulcer is a rather rare pathology that occurs exclusively in patients with long-term and poorly controlled arterial hypertension and continues to be one of the poorly studied areas of modern surgery. There are few reports on the occurrence of this pathology in the medical literature and, as a rule, describe extremely rare clinical cases. The issues of etiology, pathogenesis and differential diagnosis of this disease continue to cause debate. The article provides a review of the literature on this rare surgical pathology, presents its own clinical observation, discusses the issues of diagnosis and treatment options for this disease.Clinical case. A 56-year-old patient was admitted with complaints of a non-healing trophic ulcer on the lateral surface in the lower third of the right leg since one year ago with severe pain syndrome not adequately controlled with non-narcotic analgesics. he received treatment in an outpatient department and in the hospital, underwent courses of rheological therapy to the ulcer region as a local therapy, used a wide range of dressings of domestic and foreign origin. No positive effect was reported on the top of already administered combination therapy, the ulcer continued to increase in size. A Martorell’s ulcer was diagnosed, and a decision was made to provide a course of presurgical conservative rheological therapy with PGE1 (VAP 20 mg), antibiotic therapy, and local therapy aimed at maximal ulcer necrotic tissue clearance before the forthcoming planned surgical treatment. The patient underwent the surgery – autodermatoplasty of the trophic ulcer of the right leg with a mesh graft, continued local treatment of the ulcer using dressings with peruvian balsam and other medications on an outpatient basis without chemical and biological components from the antiseptics and healing stimulants group. Two months after the surgery, the patient had no complaints, the pain syndrome in the ulcer region completely regressed, no edema occurred in the lower operated leg, the right let ulcer completely healed with the formation of a permanent scar.Conclusion. Surgical management is the final and definitive treatment for Martorell’s chronic hypertensive ulcer and should be carried out promptly to minimize the spread of the ulcer and minimize a pain syndrome.

Analysis of quantitative sudomotor axon reflex test patterns in patients with complex regional pain syndrome diagnosed using the Budapest criteria

2019 ◽  
Vol 44 (11) ◽  
pp. 1026-1032 ◽  
Author(s):  
Ho-Jin Lee ◽  
Se Eun Kim ◽  
Jee Youn Moon ◽  
Je-Young Shin ◽  
Yong-Chul Kim
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Likelihood Ratio ◽  
Diagnostic Performance ◽  
Multivariable Analysis ◽  
Pain Syndrome ◽  
Confirmatory Test ◽  
Type I ◽  
Axon Reflex ◽  
Clinical Variables ◽  
Research Criteria

BackgroundAlthough the quantitative sensory axon reflex test (QSART) is used to evaluate sudomotor dysfunction in the diagnosis of complex regional pain syndrome (CRPS), its validity remains controversial. This study investigated the diagnostic performance of the QSART for CRPS and assessed associations between results of the QSART and other clinical variables.MethodsWe examined the electronic medical records of 196 consecutive patients who underwent the QSART with a suspected diagnosis of CRPS, during the period from January 2013 to December 2015. To assess the diagnostic performance of the QSART for CRPS based on the Budapest research criteria, we calculated sensitivity, specificity, positive likelihood ratio and negative likelihood ratio. Furthermore, we performed binary logistic regression analyses to investigate the relationships between QSART results and other clinical variables.ResultsThe sensitivity and specificity of the QSART for diagnosing CRPS were 67.6% and 40.6%, respectively. The OR for diagnosing CRPS using the QSART was not statistically significant (1.43; 95% CI 0.65 to 3.14; p=0.376), whereas it was for distinguishing CRPS types I and II (4.11; 95% CI 1.34 to 12.57; p=0.013). In multivariable analysis, there were no correlations between the results of the QSART and other variables, except hypertension (OR=0.34; 95% CI 0.13 to 0.91; p=0.032).ConclusionThe QSART showed low diagnostic value as a screening or a confirmatory test for CRPS according to the Budapest research criteria. CRPS type II was more likely than CRPS type I to result in abnormal QSART results.

Pediatric Complex Regional Pain Syndrome Type 1

2018 ◽  
Author(s):  
Bobbie Riley ◽  
Navil Sethna
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Diagnostic Tests ◽  
Treatment Options ◽  
Pain Syndrome ◽  
Underlying Mechanism ◽  
Interventional Treatment ◽  
Syndrome Type ◽  
Delay In Diagnosis ◽  
Skin Hypersensitivity

Complex regional pain syndrome type 1 (CRPS-1) is a condition that affects adolescents and children under the age of 7. It usually follows minor injury and rarely occurs spontaneously. The pain is usually out of proportion to the inciting injury. Pain, allodynia, and/or hyperalgesia are severe enough to inhibit use of the affected limb. Delay in diagnosis and self and/or iatrogenic immobilization of the affected limb may lead to worsening pain, skin hypersensitivity and discoloration, swelling, and vasomotor and dystrophic abnormalities. The diagnosis of CRPS-1 and 2 is based on symptoms. There are no diagnostic tests that can confirm the presence or absence of CRPS-1. CRPS-2 diagnosis is established by nerve conduction test and electromyography. Clinical practice neuropathic guidelines are most effective for CRPS-2 treatment. Pharmacological and interventional treatment options for CRPS-1 are limited and usually ineffective because the underlying mechanism(s) are yet to be determined.

The Budapest criteria for complex regional pain syndrome: The diagnostic challenge

2018 ◽  
Vol 02 (01) ◽  
Author(s):  
Joseph V Pergolizzi ◽  
Jo Ann LeQuang ◽  
Sri Nalamachu ◽  
Robert Taylor ◽  
Ryan W Bigelsen
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Pain Syndrome ◽  
Diagnostic Challenge ◽  
Budapest Criteria

Complex Regional Pain Syndrome

2019 ◽  
pp. 262-270
Author(s):  
Steven R. Hanling ◽  
Ian M. Fowler ◽  
C. Ryan Phillips
Keyword(s):  
Chronic Pain ◽  
Complex Regional Pain Syndrome ◽  
Pain Syndrome ◽  
Signs And Symptoms ◽  
Pain Medication ◽  
Channel Blockers ◽  
Chronic Pain Condition ◽  
Ion Channel Blockers ◽  
Budapest Criteria ◽  
Sympathetic Blocks

Complex regional pain syndrome (CRPS) is a chronic pain condition that typically occurs after injury to a limb or directly to a nerve. Progression of the disease can result in multiple debilitating symptoms including pain disproportionate to the inciting event. The Budapest criteria cateforize the constellation of signs and symptoms of CRPS (sensory, vasomotor, sudomotor/edema, and motor/trophic changes) and are used to diagnose the syndrome. Treatments include rehabilitation (physical and occupation therapy), multimodal pain medication (medications that target neuropathic pain such as antidepressants, membrane stabilizers, and ion channel blockers), interventional treatments (sympathetic blocks, infusion catheters, neuromodulation), and psychological therapy.

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