From the Guidelines
Complex Regional Pain Syndrome (CRPS) is a chronic condition characterized by severe, persistent pain that typically affects one limb after an injury or trauma, with symptoms including burning or throbbing pain, sensitivity to touch, and changes in skin color and temperature. According to the 2017 HIVMA of IDSA clinical practice guideline for the management of chronic pain in patients living with HIV 1, CRPS is also known as sympathetically maintained pain, causalgia, or reflex sympathetic dystrophy (RSD), and is described as excruciating and made worse by touch or stimulation. The pain gradually increases in intensity and size in the affected limb, sometimes spreading to the contralateral limb. Some key characteristics of CRPS include:
- Severe, persistent pain that is disproportionate to the initial injury
- Sensitivity to touch or stimulation
- Changes in skin color and temperature
- Hair loss, tissue changes, and skin discoloration at the site of the pain
- Sympathetic dysregulation is proposed to play a role in the development of CRPS 1. It is worth noting that CRPS can have a significant impact on quality of life, but with proper management, many patients experience improvement in symptoms over time.
From the Research
Definition and Characteristics of Complex Regional Pain Syndrome
- Complex regional pain syndrome (CRPS) is a regional, posttraumatic, neuropathic pain problem that most often affects one or more limbs 2.
- It is characterized by severe pain and reduced functionality, which can significantly affect an individual's quality of life 3.
- The symptomatology includes pain out of proportion in time and severity to the inciting event 4.
Diagnosis and Treatment
- The diagnosis and treatment of CRPS are often difficult as there is no one confirmatory test and no one definitive treatment 5.
- Early detection and an interdisciplinary approach to treatment appear to be key in treating CRPS 5.
- Physical therapy is the cornerstone and first-line treatment for CRPS, with mild cases responding to physical therapy and physical modalities 2.
- Interventional treatments, such as sympathetic nerve blocks and neuromodulation therapies, may also be effective in managing CRPS pain 6.
Pathophysiological Mechanisms
- Research has identified three primary pathophysiological pathways that may explain the clinical variability observed in CRPS: inflammatory mechanisms, vasomotor dysfunction, and maladaptive neuroplasticity 3.
- Investigations into these pathways have spurred the development of novel diagnostic and treatment strategies, including the use of N-Methyl-D-aspartate Receptor Antagonists (NMDA) and immune and glial-modulating agents 3.
Treatment Options
- Treatment methods being explored include immune and glial-modulating agents, intravenous immunoglobulin (IVIG) therapy, plasma exchange therapy, and neuromodulation techniques 3.
- Other treatments, such as free radical scavengers, alpha-lipoic acid (ALA), and phosphodiesterase-5 inhibitors, are also being investigated 3.
- A multidisciplinary approach, including medication, physical therapy, occupational therapy, and psychological therapy, may be necessary to manage CRPS effectively 6, 5.