Complex regional pain syndrome (CRPS; reflex sympathetic dystrophy and causalgia)
is a heterogeneous chronic pain condition that usually develops following a traumatic
injury, usually to an extremity. Although there has been considerable research regarding
the mechanisms responsible for pain in CRPS, its pathophysiology remains unclear.
The hallmark of CRPS is spontaneous and/or evoked pain. Although signs and symptoms
of sympathetic nervous system dysfunction are commonly present, not all patients demonstrate
a significant component of sympathetically maintained pain. There is no specific test
or finding that is diagnostic of CRPS, and the diagnosis is largely clinical. Treatment
of CRPS can be challenging. Management of the patient with CRPS should involve a multidisciplinary
approach, and early intervention is important in this regard. The goals of treatment
include reduction in pain but, just as important, functional restoration of the affected
body part. Management of CRPS includes any combination of pharmacotherapy, physical
and occupational therapy, regional anesthetic blocks, behavioral therapies, and surgery.
The primary surgical procedures that have been effective for CRPS include spinal cord
stimulation, intrathecal drug infusion, and sympathectomy. Surgical intervention is
usually most effective earlier rather than later, when patients have developed end-stage
CRPS.
KEYWORDS
Complex regional pain syndrome - reflex sympathetic dystrophy - causalgia - spinal
cord stimulation - sympathectomy - intrathecal therapy
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Richard K OsenbachM.D.
Division of Neurosurgery, Duke University Medical Center
Box 3807, Durham, NC 27712
Email: osenb001@mc.duke.edu
