Complex regional pain syndrome (CRPS) is a progressive multifactorial painful condition that develops usually in a limb following trauma or surgery.
Diagnosis of CRPS is guided by the Budapest criteria according to symptom presentation: constant pain, allodynia, hyperalgesia, edema, abnormal sweating, and abnormal changes in blood flow, skin colour, skin temperature and hair/nail growth, as well as motor disturbances.
There are two subtypes of CRPS: Type I indicates no sign of peripheral nerve injury and Type II denotes CRPS arising from direct nerve injury. The exact underlying biological cause of CRPS is unknown, although it is clear that CRPS involves multiple mechanisms, including vasoconstriction, deep muscle ischemia, free radical generation, peripheral nerve sensitization and inflammation.
Treatment is difficult and is typically multimodal. Conservative treatments include physical therapy, psychological therapy and medications. It is important to overcome fear of movement and to exercise the limb as motion stimulates cartilage nutrition and circulation to joints, which leads to decreased hypersensitivity.
Oral medications include nonsteroidal anti-inflammatory drugs (NSAIDs), tricyclic antidepressants (TCAs; i.e. Amitriptyline), anticonvulsants (i.e. Gabapentin), opioids and steroids. Topical medications include NSAIDs, free-radical scavengers, TCAs, anaesthetics (i.e. Ketamine), Clonidine, and Capsaicin (capsicum plant extract), and may be mixed to form combination analgesic creams. More advanced, invasive therapies include drug infusions (i.e. Pamidronate and Ketamine), nerve blocks (i.e. by injecting local anaesthetic), nerve ablation (i.e. radiofrequency neurotomy), transcutaneous electrical stimulation (TENS), surgery (i.e. to correct peripheral nerve lesions) and implantable devices (i.e. neurostimulators and intrathecal pumps).
Many people fear that their CRPS won’t be resolved, however, it is estimated that up to 80 per cent of patents experience symptom resolution or stability. Early intervention of CRPS, particularly in the first 12 months, is crucial to maximising the success of resolving CRPS.
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