title: [Current aspects of the therapy of complex regional pain syndrome].
abstract: BACKGROUND
  Complex regional pain syndrome (CRPS) constitutes an enigmatic post-traumatic pain disorder.
  
  
  OBJECTIVE
  The paper provides state of the art knowledge about CRPS.
  
  
  RESULTS
  The typical constellation of symptoms of CRPS includes pain, sensory disturbances, motor symptoms, disturbances of the autonomic control of the limbs and trophic changes. These symptoms generalize distally and go beyond single nerve innervation territories. Diagnosis is made based on clinical findings. Three-phase bone scintigraphy may be the best supporting technical investigation. Symptoms typically change during the course of CRPS. In the acute stage inflammatory symptoms prevail and during chronic stages the most expressed findings are related to central neuroplasticity. These findings include hyperalgesia, sensory loss, CRPS movement disorder, body perception disturbances and autonomic symptoms. Medical treatment with anti-inflammatory agents (steroids) or bisphosphonates is most effective in the early stages and DMSO cream might also be beneficial. Administration of i.v. ketamine has been proven effective against CRPS pain and physical therapy with behavioral components, such as pain exposure helps to overcome central reorganization and functional impairment. Psychotherapy should be offered if there are significant comorbidities. All other forms of treatment are more or less empirical. Invasive treatment should be restricted to selected cases and should only be offered in specialized centers.
  
  
  CONCLUSIONS
  If these recommendations are followed the prognosis for CRPS is not as poor as commonly assumed. Whether this means a return to the previous quality of life is unclear and often depends on very personal factors.
authors.affiliation: Klinik und Poliklinik für Neurologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55101, Mainz, Deutschland, frank.birklein@unimedizin-mainz.de.
authors.forename: F
authors.initials: F
authors.lastname: Birklein
authors.forename: T
authors.initials: T
authors.lastname: Schlereth
mesh_terms: D001341:Autonomic Nervous System / Q000503:physiopathology; D003131:Combined Modality Therapy; D020918:Complex Regional Pain Syndromes / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D003299:Cooperative Behavior; D005121:Extremities / Q000294:innervation; D006801:Humans; D033183:Interdisciplinary Communication; D009473:Neuronal Plasticity / Q000235:genetics / Q000502:physiology; D011379:Prognosis