Modern Principles of Diagnosis and Treatment in Complex Regional Pain Syndrome

Dtsch Arztebl Int, 2022 · DOI: 10.3238/arztebl.m2022.0358 · Published: December 2, 2022

Neurology Pain Management Rehabilitation

Simple Explanation

Complex Regional Pain Syndrome (CRPS) is a condition that can occur after an injury or surgery, particularly affecting the limbs. It is now classified as a primary pain condition with multiple contributing factors, rather than a skeletal or autonomic nervous system disorder. The symptoms of CRPS are not limited to the affected area but also include systemic symptoms, impacting body perception and symptom processing. Treatment is evolving to focus on active therapies that work both centrally and peripherally, rather than relying solely on passive measures. Modern treatments involve physiotherapy and occupational therapy to improve sensory perception, strength, and motor skills, alongside psychological support to reduce anxiety. Medication is used to manage pain and inflammation, and interventional procedures are reserved for severe cases.

Study Duration

Not specified

Participants

Review Article

Evidence Level

Not specified

Key Findings

1
CRPS is now categorized as a primary pain condition of multifactorial origin under the ICD-11.
2
Effective treatment involves addressing both physiological and psychological mechanisms, with the primary aim of restoring function and participation.
3
Neuropsychological symptoms relating to the affected limb can include disturbances of alertness/attentiveness, sense of body ownership/sense of position

Research Summary

Complex regional pain syndrome (CRPS) is a relatively common complication, occurring in 5% of cases after injury or surgery, particularly in the limbs. The incidence of CPRS is around 5–26/100 000. Regional findings in CRPS are accompanied by systemic symptoms, especially by neurocognitive disorders of body perception and of symptom processing. The therapeutic focus is shifting from predominantly passive peripheral measures to early active treatments acting both centrally and peripherally. The modern principles for the diagnosis and treatment of CRPS consider both, physiological and psychological mechanisms, with the primary goal of restoring function and participation. More research is needed to strengthen the evidence base in this field.

Practical Implications

Early Active Treatment

Emphasize early and active physiotherapy and occupational therapy to improve sensory perception, strength, motor skills, and sensorimotor integration.

Psychological Support

Integrate stepped psychological interventions to address anxiety, avoidance behavior, and body perception disturbances.

Judicious Use of Interventions

Limit interventional procedures to exceptional cases and perform them only in specialized centers with expertise in CRPS management.

Study Limitations

1
The evidence base for specific interventions remains limited, with few randomized controlled trials and heterogeneous populations.
2
Findings are sometimes difficult to objectify, resulting in discrepancies between history and examination.
3
Differential diagnosis of CRPS is wide-ranging, which inevitably carries with it the risk of being missed or even becoming subject to diagnostic inflation

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