title: Complex regional pain syndrome: An optimistic perspective.
abstract: Complex regional pain syndrome (CRPS) presents with clinical symptoms that can no longer be explained by the initial trauma, including pain, sensory, motor, and trophic symptoms, and impairment of autonomic control of the limb. These symptoms spread distally and go beyond single nerve innervation territories. Typically, the symptoms change through the course of CRPS as a result of the varying pathophysiology. Diagnosis is made clinically after the rigorous elimination of other possible causes, and 3-phase bone scintigraphy can be a useful tool for confirming CRPS. In acute stages, inflammatory symptoms prevail and should be treated with anti-inflammatory agents (steroids), bisphosphonates, or topical application of dimethyl sulfoxide. In chronic stages, many symptoms are related to so-called central neuroplasticity; these include hyperalgesia, sensory loss, motor symptoms, body perception disturbance, autonomic symptoms, and learned incorrect behavior such as nonuse. At this stage, the only medical treatment that is effective against pain without improving the function is ketamine infusions, but this has side effects. Physical therapy, graded motor imagery, and pain exposure/graded exposure in vivo therapy can help to overcome central reorganization. If a relevant mental comorbidity is present, the patient should be referred for psychotherapeutic treatment. Invasive treatment should be restricted to special cases and only offered after psychosomatic assessment. If these recommendations are followed, CRPS prognosis is not as poor as commonly assumed. Whether the patients can return to their previous life depends on particular individual factors.
authors.affiliation: From the Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131 Mainz. frank.birklein@unimedizin-mainz.de.
authors.forename: Frank
authors.initials: F
authors.lastname: Birklein
authors.affiliation: From the Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131 Mainz.
authors.forename: Darragh
authors.initials: D
authors.lastname: O'Neill
authors.affiliation: From the Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131 Mainz.
authors.forename: Tanja
authors.initials: T
authors.lastname: Schlereth
mesh_terms: D000700:Analgesics / Q000627:therapeutic use*; D001342:Autonomic Nervous System Diseases / Q000209:etiology / Q000628:therapy*; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D020918:Complex Regional Pain Syndromes / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D004164:Diphosphonates / Q000627:therapeutic use; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D006930:Hyperalgesia / Q000209:etiology / Q000628:therapy*; D019018:Imagery, Psychotherapy / Q000379:methods; D007171:Implosive Therapy / Q000379:methods; D007649:Ketamine / Q000627:therapeutic use; D009788:Occupational Therapy / Q000379:methods*; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D026741:Physical Therapy Modalities
chemical_list: D000700:Analgesics; D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D005938:Glucocorticoids; D007649:Ketamine