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Complex Regional Pain Syndrome: Evidence-Based Advances in Concepts and Treatments

  • Neuropathic Pain (A Abd-Elsayed, Section Editor)
  • Published:
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Abstract

Purpose of Review

This review presents the most current information about the epidemiology of complex regional pain syndrome (CRPS), classification and diagnostic criteria, childhood CRPS, subtypes, pathophysiology, conventional and less conventional treatments, and preventive strategies.

Recent Findings

CRPS is a painful disorder with multifactorial pathophysiology. The data describe sensitization of the central and peripheral nervous systems, inflammation, possible genetic factors, sympatho-afferent coupling, autoimmunity, and mental health factors as contributors to the syndrome. In addition to conventional subtypes (type I and type II), cluster analyses have uncovered other proposed subtypes. Prevalence of CRPS is approximately 1.2%, female gender is consistently associated with a higher risk of development, and substantial physical, emotional, and financial costs can result from the syndrome. Children with CRPS seem to benefit from multifaceted physical therapy leading to a high percentage of symptom-free patients. The best available evidence along with standard clinical practice supports pharmacological agents, physical and occupational therapy, sympathetic blocks for engaging physical restoration, steroids for acute CRPS, neuromodulation, ketamine, and intrathecal baclofen as therapeutic approaches. There are many emerging treatments that can be considered as a part of individualized, patient-centered care. Vitamin C may be preventive.

Summary

CRPS can lead to progressively painful sensory and vascular changes, edema, limb weakness, and trophic disturbances, all of which substantially erode healthy living. Despite some progress in research, more comprehensive basic science investigation is needed to clarify the molecular mechanisms of the disease so that targeted treatments can be developed for better outcomes. Incorporating a variety of standard therapies with different modes of action may offer the most effective analgesia. Introducing less conventional approaches may also be helpful when traditional treatments fail to provide sufficient improvement.

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Authors and Affiliations

  1. Division of Pain Medicine, Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, USA

    Gerard Limerick, Jay Karri & Paul J. Christo

  2. Department of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, USA

    Gerard Limerick & John Manor

  3. Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, USA

    Dana K. Christo

  4. Department of Anesthesiology, University of California, San Diego, CA, USA

    Jennifer Tram & Krishnan Chakravarthy

  5. Coast Spine and Sports Medicine, Covina, CA, USA

    Roya Moheimani

  6. Department of Orthopedic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA

    Jay Karri

  7. Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, USA

    Jay Karri

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Gerard Limerick: No disclosures. Dana Christo: No disclosures. Jennifer Tram: No disclosures. Roya Moheimani: No disclosures. John Manor: No disclosures. Krishnan Chakravarthy: Consultant for Medtronic, Biotronik, Mainstay Medical, PAINTEQ, Vertos Medical. He has stock options in Aya Bioscience, Higgs Boson Health, Nalu Medical, Rune Labs, UMEHEAL, Yantra Biomedical, Oska Wellness, Mainstay Medical, Neuronoff. He is founder of NXTSTIM, Coastal Research Institute, Accufix Medical, Douleur Therapeutics. Jay Karri: No disclosures. Paul Christo: Consultant for Y-mAbs, Eli Lilly, GlaxoSmithKline Consumer Healthcare, Exicure, Neurana, Neumentum.

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Limerick, G., Christo, D.K., Tram, J. et al. Complex Regional Pain Syndrome: Evidence-Based Advances in Concepts and Treatments. Curr Pain Headache Rep 27, 269–298 (2023). https://doi.org/10.1007/s11916-023-01130-5

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