From the Guidelines
Chronic regional pain syndrome, also known as complex regional pain syndrome (CRPS), is diagnosed based on clinical criteria including persistent pain disproportionate to the inciting event, along with evidence of sensory, vasomotor, sudomotor, and motor/trophic changes in the affected region, with the Budapest Criteria being the most commonly used diagnostic tool. The diagnostic criteria for CRPS require continuing pain with at least one symptom in three of four categories (sensory, vasomotor, sudomotor/edema, motor/trophic) and at least one sign in two categories.
Key Diagnostic Criteria
- Persistent pain disproportionate to the inciting event
- Evidence of sensory, vasomotor, sudomotor, and motor/trophic changes in the affected region
- At least one symptom in three of four categories (sensory, vasomotor, sudomotor/edema, motor/trophic)
- At least one sign in two categories
Treatment for CRPS requires a multidisciplinary approach centered on physical and occupational therapy to maintain function and reduce disability.
Treatment Options
- Medication options:
- NSAIDs like ibuprofen for mild pain
- Anticonvulsants such as gabapentin (starting at 300mg daily, increasing to 1800-3600mg daily in divided doses) or pregabalin (150-600mg daily in divided doses) for neuropathic pain, as seen in the management of erythromelalgia 1
- Antidepressants like duloxetine or amitriptyline
- In some cases, bisphosphonates like alendronate to address bone changes
- Interventional procedures:
- Sympathetic nerve blocks
- Spinal cord stimulation
- Intrathecal drug delivery
- Psychological support is also essential, as chronic pain significantly impacts mental health and quality of life. Early diagnosis and treatment are crucial, as CRPS becomes increasingly difficult to manage over time, with the goal being functional restoration rather than complete pain elimination.
From the Research
Diagnostic Criteria for Chronic Regional Pain Syndrome
- The diagnosis of chronic regional pain syndrome (CRPS) is based on the modified Budapest Criteria 2
- CRPS is characterized by sensory, vasomotor, sudomotor, motor, and trophic changes 2, 3
- The clinical spectrum develops individually and changes over time 2
- Essential differential diagnosis includes infections, neurological compression, and inflammatory conditions 2
Treatment Options for Chronic Regional Pain Syndrome
- Treatment is based on the presenting clinical signs or symptoms and includes a variety of pharmacological, interventional, physiotherapeutic, occupational, and psychiatric measures 2
- Pharmacological agents, physical and occupational therapy, sympathetic blocks, steroids, neuromodulation, ketamine, and intrathecal baclofen are therapeutic approaches 4
- Vitamin C may be preventive 4
- Controlled trials have demonstrated that a short course of oral corticosteroids, intranasal or intramuscular calcitonin, intravenous bisphosphonates, free-radical scavengers, gabapentin, regional intravenous sympathetic blocks with bretylium, and spinal cord stimulation or physical therapy and occupational therapy can be efficacious for CRPS 5
- Children with CRPS seem to benefit from multifaceted physical therapy leading to a high percentage of symptom-free patients 6, 4
Clinical Manifestations and Pathophysiology
- CRPS affects mainly women between 61 and 70 years, and the upper extremity is mainly involved 2
- The pathophysiology is poorly understood, but many features suggest both peripheral and central nervous system involvement 6
- Sensitization of the central and peripheral nervous systems, inflammation, possible genetic factors, sympatho-afferent coupling, autoimmunity, and mental health factors are contributors to the syndrome 4