COMPLEX REGIONAL PAIN SYNDROME

Course overview

COMPLEX REGIONAL PAIN SYNDROME (CRPS) IS A NEUROPATHIC PAIN DISORDER DEFINED BY THE PRESENCE OF DISTINCT CLINICAL FEATURES, INCLUDING ALLODYNIA, HYPERALGESIA, SUDOMOTOR AND VASOMOTOR ABNORMALITIES, AND TROPHIC CHANGES. THE PAIN EXPERIENCED IS DISPROPORTIONATE TO THE DEGREE OF TISSUE INJURY AND PERSISTS BEYOND THE NORMAL EXPECTED TIME FOR TISSUE HEALING. THE PATHOPHYSIOLOGY IS MULTIFACTORIAL AND INVOLVES PAIN DYSREGULATION IN THE SYMPATHETIC AND CENTRAL NERVOUS SYSTEMS, WITH LIKELY GENETIC, INFLAMMATORY, AND PSYCHOLOGICAL CONTRIBUTIONS. THERE ARE TWO SUBTYPES: TYPE I, FORMERLY KNOWN AS REFLEX SYMPATHETIC DYSTROPHY, AND TYPE II, FORMERLY KNOWN AS CAUSALGIA. TYPE I OCCURS IN THE ABSENCE OF NERVE TRAUMA, WHILE TYPE II OCCURS IN THE SETTING OF KNOWN NERVE TRAUMA. CLINICALLY THEY ARE INDISTINGUISHABLE AND FOLLOW A REGIONAL RATHER THAN DERMATOMAL OR PERIPHERAL NERVE DISTRIBUTION. CPRS FAVORS THE DISTAL EXTREMITIES, THOUGH SPREAD BEYOND THE INITIALLY AFFECTED AREA COMMONLY OCCURS IN THE PROXIMAL OR CONTRALATERAL LIMB. CRPS IS FURTHER SUBDIVIDED INTO "WARM" VERSUS "COLD" AND SYMPATHETICALLY-MAINTAINED VERSUS SYMPATHETICALLY-INDEPENDENT, WHICH MAY AFFECT PROGNOSIS AND TREATMENT OPTIONS. THIS ACTIVITY DESCRIBES THE EVALUATION AND MANAGEMENT OF COMPLEX REGIONAL PAIN SYNDROME AND HIGHLIGHTS THE ROLE OF THE INTERPROFESSIONAL TEAM IN IMPROVING CARE FOR AFFECTED PATIENTS.