A brief review of complex regional pain syndrome and current management

Annals of Medicine, 2024 · DOI: https://doi.org/10.1080/07853890.2024.2334398 · Published: April 16, 2024

Anesthesiology Neurology Pain Management

Simple Explanation

Complex Regional Pain Syndrome (CRPS) is a chronic pain condition that can significantly impact a patient's life. It is important to have a thorough diagnosis, because this is a diagnosis of exclusion. Treatment approaches are broad and can range from physical therapy to more invasive options like spinal cord stimulation. The Budapest criteria is a diagnostic tool to assist in the diagnosis of CRPS. This tool takes into consideration sensory, vasomotor, sudomotor/edema, and motor/trophic changes. CRPS can be difficult to treat, and can be caused by a number of mechanisms. It is important to have a multimodal approach to address the potential multifactorial pathological development of CRPS.

Study Duration

Not specified

Participants

1043 patients were mentioned regarding signs and symptoms in patients with complex regional pain syndrome

Evidence Level

Review Article

Key Findings

1
CRPS can be classified into two main categories: type 1 and type 2, with type 2 resulting from nerve damage.
2
The Budapest criteria has a sensitivity of 0.76 and a specificity of 0.81 when utilizing 3 of 4 symptom and 2 of 4 sign decision rules for diagnosis.
3
DRG stimulation was found to be more efficient than conventional SCS in this multicenter randomized trial for reducing pain and enhancing quality of life in CRPS patients.

Research Summary

Complex regional pain syndrome (CRPS) is a debilitating and complex condition that places a significant physical, psychological and emotional burden upon afflicted patients necessitating multi-modal approaches to treatment. The development of the Budapest criteria provided a robust and well-tested set of diagnostic criteria to aid clinicians in the diagnosis of CRPS. Invasive treatments offer promising results, especially when considering dorsal root ganglion stimulation; however, the need for more robust clinical trials remains, especially when considering a small portion of patients who have refractory CRPS resort to amputation to control their pain symptoms.

Practical Implications

Improved Diagnostic Accuracy

The Budapest criteria, refined by the Valencia consensus, offers a more standardized and specific approach to diagnosing CRPS, reducing the likelihood of overdiagnosis.

Personalized Treatment Strategies

Understanding the warm vs cold subtypes, as well as considering autoimmune components of CRPS, can guide the development of tailored treatment plans.

Multimodal Interventions

Given the multifactorial nature of CRPS, employing a combination of physical, occupational, psychological therapies, along with medical and interventional approaches, is essential for comprehensive management.

Study Limitations

1
Lack of understanding regarding the underlying pathophysiology of CRPS.
2
The quality of the evidence was low regarding sympathetic blocks, as well as their short- and long-term analgesic effects.
3
The range of benefits is variable and there remains a paucity of evidence regarding these modalities; however, given the current understanding and proposed pathophysiological mechanisms, these interventions are logical in their employment.

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