Complex regional pain syndrome

NewsBot · Jun 25, 2008

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Complex regional pain syndrome 1 - the Swiss cohort study.
Brunner F, Bachmann LM, Weber U, Kessels AG, Perez RS, Marinus J, Kissling R.
BMC Musculoskelet Disord. 2008 Jun 23;9(1):92. [Epub ahead of print]

BACKGROUND: Little is known about the course of Complex Regional Pain Syndrome 1 and potential factors influencing the course of this disorder over time. The goal of this study is a) to set up a database with patients suffering from suspected CRPS 1 in an initial stadium, b) to perform investigations on epidemiology, diagnosis, prognosis, and socioeconomics within the database and c) to develop a prognostic risk assessment tool for patients with CRPS 1 taking into account symptomatology and specific therapies.

METHODS: Prospective cohort study. Patients suffering from a painful swelling of the hand or foot which appeared within 8 weeks after a trauma or a surgery and which cannot be explained by conditions that would otherwise account for the degree of pain and dysfunction will be included. In accordance with the recommendations of International Classification of Functioning, Disability and Health (ICF model), standardised and validated questionnaires will be used. Patients will be monitored over a period of 2 years at 6 scheduled visits (0 and 6 weeks, 3, 6, 12, and 24 months). Each visit involves a physical examination, registration of therapeutic interventions, and completion of the various study questionnaires. Outcomes involve changes in health status, quality of life and costs/utility.

DISCUSSION: This paper describes the rationale and design of patients with CRPS 1. Ideally, potential
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Full paper

Admin2 · Jun 25, 2008

Related threads:
RSD
Chronic Regional Pain Syndrome / Sudecks
Other pain management threads

NewsBot · Sep 23, 2008

An Open-label Pilot Trial of Ibandronate for Complex Regional Pain Syndrome.
Breuer B, Pappagallo M, Ongseng F, Chen CI, Goldfarb R.
Clin J Pain. 2008 Oct;24(8):685-9.

OBJECTIVE: Complex regional pain syndrome (CRPS) type I, also known as reflex sympathetic dystrophy, usually develops after trauma or immobilization, is characterized by focal pain and autonomic dysregulation, and sometimes focal trophic changes such as osteoporosis. The pathophysiology is unknown and there have been few controlled treatment trials. The purpose of this study was to obtain pilot data on the safety and efficacy of a highly potent bisphosphonate, ibandronate, for the treatment of CRPS, which might be responsive to bisphosphonates' inhibition of osteoclast and anti-inflammatory activity.

METHODS: An open-label trial (n=10) of 6 mg ibandronate infusions was administered on each of 3 days. The infusions were preceded by a 2-week baseline period, and followed by a 4-week follow-up period.

RESULTS: One participant dropped out after the first infusion because of a decreased glomerular filtration rate. Otherwise, aside from transitory flu-like symptoms characteristic of bisphosphonate treatments, the drug was well tolerated. Significant postintervention improvements were observed in average and worst pain ratings; the neuropathic pain qualities of "unpleasant," "sensitive," "deep," "intense," "surface," "hot," "cold," "sharp," and "dull"; and hyperalgesia and allodynia. Participants with hand CRPS improved significantly more than those with foot CRPS in average and worst pain, as well as in the following neuropathic pain qualities: "dull," "intense," "deep," and "time."

DISCUSSION: These data justify a randomized, double-blind, placebo-controlled trial of ibandronate that should perhaps be limited to patients with hand CRPS.
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NewsBot · Oct 16, 2008

Not a lot of information on this case, but it notable at it affects the foot and was only from skin surgery:

Complex regional pain syndrome after dermatological surgery.
Kumar S, Mackay C, O'Callaghan J, De'Ambrosis B.
Australas J Dermatol. 2008 Nov;49(4):242-4.

We report a case of complex regional pain syndrome developing in a 57-year-old woman after minor skin surgery in the sole of her right foot. This was diagnosed and treated in its early phase with sympathetic blockade using guanethedine with complete recovery of symptoms
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NewsBot · Oct 22, 2009

Effect of vitamin C on prevention of complex regional pain syndrome type I in foot and ankle surgery.
Besse JL, Gadeyne S, Galand-Desmé S, Lerat JL, Moyen B.
Foot Ankle Surg. 2009;15(4):179-82.

BACKGROUND: The public health cost impact of complex regional pain syndrome type I (CRPS I) is considerable in both emergency and scheduled orthopaedic surgery. We proposed to assess the effectiveness of vitamin C in prevention of CRPS I in foot and ankle surgery.

METHODS: We carried out a "before-after" quasi-experimental study comparing two chronologically successive groups without (Group I: July 2002-June 2003) and with (Group II: July 2003-June 2004) preventive 1g daily vitamin C treatment. All patients having surgery on the foot or ankle were enrolled, with the exception of diabetic foot cases. Several factors were analysed: sex, age, type of pathology, history of CRPS I, psychological context, tourniquet time, and cast immobilisation time.

RESULTS: 420 feet (392 patients) were included in the study: 185 in Group I, 235 in Group II. CRPS I occurred in 18 cases in Group I (9.6%) and 4 cases in Group II (1.7%) (p<10(-4)), with history of CRPS I as a significantly correlated factor (relative risk=10.4). The psychological context (anxio-depressive state) showed a (sub-significant) tendency to increase the risk of CRPS I (relative risk=2.6).

CONCLUSION: Vitamin C has been shown to be effective in preventing CRPS I secondary to wrist fracture, but few data are available with respect to foot and ankle cases. The present study demonstrates the effectiveness of vitamin C in preventing CRPS I of the foot and ankle-a frequent complication in our control group (9.6%). The authors recommend preventive management by vitamin
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NewsBot · Sep 17, 2012

Efficacy and Safety of High-dose Vitamin C on Complex Regional Pain Syndrome in Extremity Trauma and Surgery—Systematic Review and Meta-Analysis
Naohiro Shibuya, Jon M. Humphers, Monica R. Agarwal, Daniel C. Jupiter
Journal of Foot and Ankle Surgery (in press)

Complex regional pain syndrome (CRPS) is a devastating condition often seen after foot and ankle injury and surgery. Prevention of this pathology is attractive not only to patients but also to surgeons, because the treatment of this condition can be difficult. We evaluated the effectiveness of vitamin C in preventing occurrence of CRPS in extremity trauma and surgery by systematically reviewing relevant studies. The databases used for this review included: Ovid EMBASE, Ovid MEDLINE, CINAHL, and the Cochrane Database. We searched for comparative studies that evaluated the efficacy of more than 500 mg of daily vitamin C. After screening for inclusion and exclusion criteria, we identified 4 studies that were relevant to our study question. Only 1 of these 4 studies was on foot and ankle surgery; the rest concerned the upper extremities. All 4 studies were in favor of this intervention with minimal heterogeneity (Tau2 = 0.00). Our quantitative synthesis showed a relative risk of 0.22 (95% confidence interval = 0.12, 0.39) when daily vitamin C of at least 500 mg was initiated immediately after the extremity surgery or injury and continued for 45 to 50 days. A routine, daily administration of vitamin C may be beneficial in foot and ankle surgery or injury to avoid CRPS. Further foot and ankle specific and dose-response studies are warranted.
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NewsBot · Oct 4, 2012

Systemic Complications of Complex Regional Pain Syndrome
Robert J. Schwartzman
Neuroscience & Medicine Vol.3 No.3, September 2012

Complex Regional Pain Syndrome (CRPS) is a neuropathic pain disorder that is characterized by: 1) Severe pain beyond the area of injury; 2) Autonomic dysregulation; 3) Neuropathic edema; 4) A movement disorder, atrophy and dystrophy. It is most often caused by a fracture, soft-tissue injury or surgical procedure and is divided into Type I, in which no nerve lesion is identified (classic reflex sympathetic dystrophy), and Type II where a specific nerve has been damaged (causalgia). In addition to the peripheral manifestations, there are many internal medical complications whose etiology is often not appreciated. This article will examine how CRPS affects the systems of: cognition; constitutional, cardiac, and respiratory complications; systemic autonomic dysregulation; neurogenic edema; musculoskeletal, endocrine and dermatological manifestations; as well as urological and gastrointestinal function.
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NewsBot · Oct 9, 2012

Treatment of complex regional pain syndrome in adults: A systematic review of randomized controlled trials published from June 2000 to April 2010
L. Cossins et al
European Journal of Pain (in press)

Complex regional pain syndrome (CRPS) is a disabling pain condition with sensory, motor and autonomic manifestations. Uncertainty remains about how CRPS can be effectively managed. We conducted a systematic review of randomized controlled trials (RCTs) for treatment and prophylactic interventions for CRPS published during the period 2000–2012, building on previous work by another group reviewing the period 1966–2000. Bibliographic database searches identified 173 papers which were filtered by three reviewers. This process generated 29 trials suitable for further analysis, each of which was reviewed and scored by two independent reviewers for methodological quality using a 15-item checklist. A number of novel and potentially effective treatments were investigated. Analysing the results from both review periods in combination, there was a steep rise in the number of published RCTs per review decade. There is evidence for the efficacy of 10 treatments (3× strong – bisphosphonates, repetitive transcranial magnetic stimulation and graded motor imagery, 1× moderate and 6× limited evidence), and against the efficacy of 15 treatments (1× strong, 1× moderate and ×13 limited). The heterogeneity of trialled interventions and the pilot nature of many trials militate against drawing clear conclusions about the clinical usefulness of most interventions. This and the observed phenomenon of excellent responses in CRPS subgroups would support the case for a network- and multi-centre approach in the conduct of future clinical trials. Most published trials in CRPS are small with a short follow-up period, although several novel interventions investigated from 2000 to 2012 appear promising.
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NewsBot · Nov 20, 2012

Complex Regional Pain Syndrome Acceptance and the Alternative Denominations in the Medical Literature
Jasmina Todorova, Nikolaj Dantchev, Guenka Petrova
Med Princ Pract (in press)

Objective: To analyze the use of the term ‘complex regional pain syndrome’ in the medical literature and evaluate whether or not the traditional names ‘reflex sympathetic dystrophy’ and ‘causalgia’ have already been replaced with the new terms ‘complex regional pain syndrome type I’ and ‘complex regional pain syndrome type II’, respectively.

Materials and Methods: The Scopus and PubMed databases were searched for reports written between 2001 and 2012 for the following descriptors in the titles: ‘complex regional pain syndrome’, ‘complex regional pain syndrome type I’, ‘complex regional pain syndrome type 1’, ‘complex regional pain syndrome type II’, ‘complex regional pain syndrome type 2’, ‘CRPS’, ‘CRPS type I’, ‘CRPS type 1’, ‘CRPS type II’, ‘CRPS type 2’, ‘reflex sympathetic dystrophy’, ‘algodystrophy’, ‘algoneurodystrophy’, ‘causalgia’, ‘transient osteoporosis’, ‘Sudeck’, and ‘shoulder-hand syndrome’.

Results: Systematization of the 1,318 articles found yielded the following: 953 (72.31%) articles for the descriptor ‘complex regional pain syndrome’ and a further 94 (7.13%) for its abbreviation ‘CRPS’; 180 (13.66%) for ‘reflex sympathetic dystrophy’; 33 (2.50%) for ‘shoulder-hand syndrome’; 29 (2.20%) for ‘algodystrophy’; 13 (0.99%) for ‘causalgia’; 13 (0.99%) for ‘Sudeck’; 2 (0.15%) for ‘algoneurodystrophy’, and 1 (0.08%) for ‘transient osteoporosis’. The total number of articles using new terminology represents 1,047 (79.44%) of all articles.

Conclusion: The new neutral term ‘complex regional pain syndrome’ was most commonly used and will likely replace the traditional names ‘reflex sympathetic dystrophy’ and ‘causalgia’. The new terminology is now widely accepted by the medical professionals who are mostly engaged in the treatment of CRPS patient
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NewsBot · Jan 4, 2013

Inflammation in complex regional pain syndrome; A systematic review and meta-analysis
Luke Parkitny, et al
Neurology January 1, 2013 vol. 80 no. 1 106-117

Objectives: We conducted a systematic review of the literature with meta-analysis to determine whether complex regional pain syndrome (CRPS) is associated with a specific inflammatory profile and whether this is dependent on the duration of the condition.

Methods: Comprehensive searches of the literature using MEDLINE, Embase, Scopus, Web of Science, and reference lists from published reviews identified articles that measured inflammatory factors in CRPS. Two independent investigators screened titles and abstracts, and performed data extraction and risk of bias assessments. Studies were subgrouped by medium (blood, blister fluid, and CSF) and duration (acute and chronic CRPS). Where possible, meta-analyses of inflammatory factor concentrations were performed and pooled effect sizes were calculated using random-effects models.

Results: Twenty-two studies were included in the systematic review and 15 in the meta-analysis. In acute CRPS, the concentrations of interleukin (IL)-8 and soluble tumor necrosis factor receptors I (sTNF-RI) and II (sTNF-RII) were significantly increased in blood. In chronic CRPS, significant increases were found in 1) TNFα, bradykinin, sIL-1RI, IL-1Ra, IL-2, sIL-2Ra, IL-4, IL-7, interferon-γ, monocyte chemoattractant protein-1 (MCP-1), and sRAGE (soluble receptor for advanced glycation end products) in blood; 2) IL-1Ra, MCP-1, MIP-1β, and IL-6 in blister fluid; and 3) IL-1β and IL-6 in CSF. Chronic CRPS was also associated with significantly decreased 1) substance P, sE-selectin, sL-selectin, sP-selectin, and sGP130 in blood; and 2) soluble intercellular adhesion molecule-1 (sICAM-1) in CSF. Most studies failed to meet 3 or more of our quality criteria.

Conclusion: CRPS is associated with the presence of a proinflammatory state in the blood, blister fluid, and CSF. Different inflammatory profiles were found for acute and chronic cases.
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NewsBot · Jan 4, 2013

Establishing a relationship between bacteria in the human gut and Complex Regional Pain Syndrome
Erin R. Reichenberger et al
Brain, Behavior, and Immunity; 20 December 2012

Complex Regional Pain Syndrome (CRPS) is a serious and painful condition involving the peripheral and central nervous systems. Full comprehension of the disorder’s pathophysiology remains incomplete, but research implicates the immune system as a contributor to chronic pain. Because of the impact gastrointestinal bacteria have in the development and behavior of the immune system, this study compares the GI microbial communities of 16 participants with CRPS (5 of whom have intestinal discomforts) and 16 healthy controls using 454 sequencing technology. CRPS subjects were found to have significantly less diversity than their healthy counterparts. Statistical analysis of the phylogenetic classifications revealed significantly increased levels of Proteobacteria and decreased levels of Firmicutes in CRPS subjects. Clustering analysis showed significant separation between healthy controls and CRPS subjects. These results support the hypothesis that the GI microbial communities of CRPS participants differ from those of their healthy counterparts. These variations may hold the key to understanding how CRPS develops and provide information that could yield a potential treatment.
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NewsBot · May 23, 2013

Complex Regional Pain Syndrome: A Guide for Recognition and Treatment

NewsBot · Mar 7, 2014

Incidence of Complex Regional Pain Syndrome after Foot and Ankle Surgery
Matthew J. Rewhorn, MBCHB, Andraay H. Leung, MBCHB, MRCS, Alan Gillespie, MBCHB, J. Stuart Moir, MBCHB, FRCS, Orth, Roslyn Miller, MBCHB, FRCS, Orth
Journal of Foot and Ankle Surgery; Article in Press

Complex regional pain syndrome (CRPS) is an uncommon complication of orthopedic surgery, and few investigators have considered the incidence in foot and ankle surgery. In the present retrospective cohort study of 390 patients who had undergone elective foot and/or ankle surgery in our department from January to December 2009, the incidence of postoperative CRPS was calculated and explanatory variables were analyzed. A total of 17 patients (4.36%) were identified as meeting the International Association for the Study of Pain criteria for the diagnosis of CRPS. Of the 17 patients with CRPS, the mean age was 47.2 ± 9.7 years, and 14 (82.35%) were female. All the operations were elective, and 9 (52.94%) involved the forefoot, 3 (17.65%) the hindfoot, 3 (17.65%) the ankle, and 2 (11.76%) the midfoot. Twelve patients (70.59%) had new-onset CRPS after a primary procedure, and 5 (29.41%) had developed CRPS after multiple surgeries. Three patients (17.65%) had documented nerve damage intraoperatively and thus developed new-onset CRPS type 2. Blood test results were available for 14 patients (82.35%) at a minimum of 3 months postoperatively, and none had elevated inflammatory markers. Five of the patients (29.41%) were smokers, and 8 (47.06%) had had a pre-existing diagnosis of anxiety and/or depression. From our findings, we recommend that middle-age females and those with a history of anxiety or depression, who will undergo elective foot surgery, should be counseled regarding the risk of developing CRPS during the consent process. We recommend similar studies be undertaken in other orthopedic units, and we currently are collecting data from other orthopedic departments within Scotland.
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NewsBot · Aug 16, 2014

Improvement of complex regional pain syndrome after plasmapheresis
F. Blaes et al
European Journal of Pain; Early View

Complex regional pain syndrome is a severe complication following trauma that is associated with vasomotor, sudomotor and sensory disturbances in an affected limb or region of the body. The exact physiopathology is not fully understood yet. Recently, autoantibody findings suggested an immune-mediated physiopathology of the disease. We here describe two otherwise treatment-resistant patients with complex regional pain syndrome and high-titre beta2 adrenergic receptor autoantibodies, who did respond to plasmapheresis. Both patients showed strong improvement of pain and autonomic symptoms measured by impairment level sum score.
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NewsBot · Jan 18, 2015

A Systematic Review of Ketamine for Complex Regional Pain Syndrome
Sara B. Connolly, Joshua P. Prager, and Harden R. Norman
Pain Medicine; Early View

Objective
This systematic review aims to examine the available literature and to synthesize published data concerning the treatment of Complex Regional Pain Syndrome (CRPS) with ketamine.

Methods
The search was conducted utilizing the databases Medline, Embase and the Cochrane Central Registry of Controlled Trials. All relevant articles were systematically reviewed.

Results
The search yielded 262 articles, 45 of which met the inclusion/exclusion criteria. Of those included, 6 were reviews, 5 were randomized placebo-controlled trials, 13 were observational studies, and 21 were case reports.

Conclusion
There is no high quality evidence available evaluating the efficacy of ketamine for CRPS and all manuscripts examined in this review were of moderate to low quality. Therefore, we conclude there is currently only weak evidence supporting the efficacy of ketamine for CRPS, yet there is clearly a rationale for definitive study.
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NewsBot · Mar 25, 2015

Complex regional pain syndrome-significant progress in understanding.
Birklein F, Schlereth T.
Pain. 2015 Apr;156 Suppl 1:S94-S103.

Research into complex regional pain syndrome (CRPS) has made significant progress. First, there was the implementation of the official IASP "Budapest" diagnostic criteria. It would be desirable to also define exclusion and outcome criteria that should be reported in studies. The next step was to recognize the complex pathophysiology. After trauma, some inflammation is physiological; in acute CRPS, this inflammation persists for months. There is an abundance of inflammatory and a lack of anti-inflammatory mediators. This proinflammatory network (cytokines and probably also other mediators) sensitizes the peripheral and spinal nociceptive system, it facilitates the release of neuropeptides from nociceptors inducing the visible signs of inflammation, and it stimulates bone cell or fibroblast proliferation, and endothelial dysfunction leading to vascular changes. Trauma may also expose nervous system structures to the immune system and triggers autoantibodies binding to adreno- and acetylcholine receptors. In an individual time frame, the pain in this inflammatory phase pushes the transition into "centralized" CRPS, which is dominated by neuronal plasticity and reorganization. Sensory-motor integration becomes disturbed, leading to a loss of motor function; the body representation is distorted leading to numbness and autonomic disturbances. In an attempt to avoid pain, patients neglect their limb and learn maladaptive nonuse. The final step will be to assess large cohorts and to analyze these data together with data from public resources using a bioinformatics approach. We could then develop diagnostic toolboxes for individual pathophysiology and select focused treatments or develop new ones.
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NewsBot · Jan 7, 2016

Amputation as an Unusual Treatment for Therapy-Resistant Complex Regional Pain Syndrome, Type 1.
Kashy BK, Abd-Elsayed AA, Farag E, Yared M, Vakili R, Esa WA
Ochsner J. 2015 Winter;15(4):441-2. doi: 10.1043/TOJ-14-0074

BACKGROUND:
Complex regional pain syndrome, type 1 (CRPS-1) causes severe pain that can be resistant to multiple treatment modalities. Amputation as a form of long-term treatment for therapy-resistant CRPS-1 is controversial.
CASE REPORT:
We report the case of a 38-year-old man who failed all treatment modalities for CRPS-1, including medication, steroid injections, and spinal cord stimulator implantation. Below-the-knee amputation to relieve intractable foot and ankle pain resulted in a favorable outcome for this patient.
CONCLUSION:
Select patients with severe CRPS-1 who are unresponsive to all forms of treatment for pain may benefit from amputation as a last option for relief of suffering. Larger studies are needed to prove the efficacy of amputation.
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NewsBot · Apr 12, 2016

Incidence of Complex Regional Pain Syndrome I Following Foot and Ankle Fractures Using the Budapest Criteria.
Bullen M, Lang C, Tran P.
Pain Med. 2016 Apr 10. pii: pnw055

OBJECTIVE : Fractures are a well-recognized inciting event in the development of complex regional pain syndrome. This study aimed to prospectively determine the incidence of complex regional pain syndrome following foot and ankle fractures.
METHODS : A prospective study was conducted of patients presenting to two metropolitan hospitals with plain radiograph diagnosis of fractures to the foot or ankle. Patients were initially screened by phone 3 months after injury using the validated International Association for the Study of Pain Budapest criteria. Patients who fulfilled the screening criteria were then physically examined by a pain specialist to assess clinical signs as part of the Budapest criteria.
RESULTS : A total of 306 consecutive eligible patients were included. One hundred and ten patients reported at least one symptom of complex regional pain syndrome; however, only three fulfilled the minimum requirements to necessitate clinical review. Of these three, only one patient fulfilled the combination of symptom and sign criteria for a positive diagnosis according to the validated Budapest criteria. The incidence of complex regional pain syndrome following foot and ankle fracture in this study was 0.3%.
CONCLUSION : Although many patients may experience vasomotor, sensory, and sudomotor disturbance following a fracture to the foot and ankle, the observed incidence of complex regional pain syndrome using a prospectively collected validated criteria is significantly lower than previously published.
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NewsBot · Jun 12, 2016

Phenotypic Variation in Complex Regional Pain Syndrome: Comparison Between Presentation in Knee Alone or in Ankle/Foot.
van Bussel CM et al
Pain Med. 2016 Jun 10. pii: pnw119

OBJECTIVE:
To compare the phenotypes of patients with complex regional pain syndrome (CRPS) of the knee to those with CRPS of the ankle/foot.
SETTING:
A retrospective study.
SUBJECTS:
Patients with CRPS of the knee and patients with CRPS of the ankle/foot.
METHODS:
We used electronic patient databases to identify patients with CRPS of the knee and patients with CRPS of the ankle/foot. The following variables were recorded: age, gender, duration of complaints, initial injury, and symptoms and signs. Frequency distributions and statistical significant differences between the groups were determined.
RESULTS:
Included were 50 patients with CRPS of the knee and 64 patients with CRPS of the ankle/foot. These patients were all diagnosed with CRPS according to the criteria used at the time of diagnosis. No significant differences were found in demographic characteristics. A few symptoms and signs appeared to be proportionally more prevalent in patients with CRPS of the ankle/foot. However, patients with CRPS of the knee suffered significantly longer from the disease than patients with CRPS of the ankle/foot.
CONCLUSIONS:
Some signs and symptoms appeared to be statistically significantly more prevalent in CRPS of the ankle/foot than in CRPS confined to the knee. We conclude that the phenotypes of CRPS confined to the knee and CRPS of the ankle/foot are comparable, but not identical. This can be a reason why CRPS in patients with pain of the knee, that is disproportionate to the initial trauma, is sometimes not recognized.
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NewsBot · Jul 18, 2016

Complex regional pain syndrome
Maria Galve-Villal, Bjarne Rittig-Rasmussen, Lene Moeller Schear Mikkelsenl, Anne Groendahl Poulsen
Manual Therapy; Article in Press

Highlights
•CRPS is painful and disabling condition generally after surgery or trauma.
•Treatment to CRPS should be delivered in a specialist interdisciplinary environment.
•The physiotherapy treatment should be individualised and include GMI and exercise.
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Introduction
Complex regional pain syndrome (CRPS) is a chronic pain condition that can occur after a minor trauma or surgery. It is a multifactorial condition with a complex cause and even more complex pathophysiology. There are disturbances and changes in the sympathetic, somatosensory and motor nervous system, resulting in severe pain and disability. Patients with CRPS can have their quality of life and functional ability greatly affected and they need appropriate and interdisciplinary interventions.

Purpose
This article contributes towards an up-to-date knowledge and an overall view of CRPS, which can contribute to a structured and systematic rehabilitation process for patients.

Implications
This Masterclass describes a functional restoration algorithm to assist therapists in the development of a treatment plan based on the available evidence and international guidelines. Early diagnosis and treatment is of great importance as patients (adults and children), can be severely affected in their functional capacity and quality of life.
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NewsBot · Jul 25, 2016

Successful Treatment of Lower Limb Complex Regional Pain Syndrome following Three Weeks of Hyperbaric Oxygen Therapy.
Katznelson R et al
Pain Res Manag. 2016;2016:3458371

Hyperbaric oxygen therapy (HBOT) is a treatment that delivers 100% oxygen at increased atmospheric pressures. The efficacy of HBOT for treating pain has been described in various animal pain models and may have clinical efficacy in the treatment of human chronic pain syndromes. We present our experience with posttraumatic Complex Regional Pain Syndrome (CRPS) type 2 in a patient who underwent 15 sessions of HBOT. A 41-year-old male with one-year history of CRPS of left foot followed by left ankle fracture demonstrated less pain, decreased swelling, less allodynia, and improvement in skin color and range of motion of the lower limb after 3 weeks of HBOT. Patient was back to work for the first time in over a year. HBOT may be considered as a valuable therapeutic tool in the treatment of long-standing CRPS.
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NewsBot · Apr 11, 2017

Neuromodulation in Treating Complex Regional Pain Syndrome: A Critical Review of The Evidence.
Picarelli H, Sterman-Neto H, Lima De-Oliveira M, et al.
J Neurol Neurosci. 2017, 8:1. Doi: 10.21767/2171-6625.1000173

Background and objectives: The management of complex regional pain syndrome (CRPS) remains a challenging task therefore a large number of interventions have been investigated. Lately, invasive and non-invasive neuromodulation have been coming up as an alternative for some patients even as an add-on treatment to medicines or physical therapy. The objective of this review is to evaluate the evidence of its effectiveness in CRPS chronic pain management.

Methods: We have used key words referring to neuromodulation techniques and CRPS to select studies from Medline, Lilacs and Cochrane Library databases. All relevant articles which have described any kind of neuromodulation as CRPS primary treatment have been reviewed by two independent researchers to assign the level of evidence according to Oxford Level of Evidence. A third researcher was consulted in dubious cases to get to the final conclusion.

Results: Although a variety of methods and devices have been used, the evidences are still poor. There is no level 1 study which confers grade A of recommendation for any method of neuromodulation in the CRPS treatment. Repetitive transcranial magnetic stimulation (rTMS) over the motor cortex and spinal cord stimulation (SCS) were the techniques with the best grade of recommendation (B or C).

Conclusion: The literature still lacks high-quality evidence supporting neuromodulation effectiveness in CRPS pain treatment. We found only a few studies that had approached this issue properly. Those facts themselves were the main limitation of this study and of those that must be coming soon. High-quality multicentre trials ought to be performed for definitive conclusions.
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NewsBot · Oct 8, 2017

CRPS: What’s the best treatment?

NewsBot · Aug 16, 2019

The long-term effect of complex regional pain syndrome type 1 on disability and quality of life after foot injury.
Mouraux D et al
Disabil Rehabil. 2019 Aug 14:1-9

Purpose: To study the long-term evolution of patients with lower-limb Complex Regional Pain Syndrome (CRPS), focusing on functional and proprioceptive aspects and quality of life. Methods: In 20 patients suffering from chronic distal lower-limb CRPS diagnosed using Budapest criteria, we assessed joint position sense and strength of the knee muscles at the CRPS and unaffected leg, functional exercise capacity, pain, CRPS severity score, quality of life and kinesiophobia. Similar assessments were performed in 20 age-matched controls. Results: The joint position performance (at 45°) was significantly lower for the CRPS leg as compared to controls. The knee extensor strength of the CRPS leg was significantly reduced as compared to the unaffected leg (-27%) and controls (-42%). CRPS patients showed significantly reduced performance at the 6 min-walk test as compared to their age group predicted value and controls. Patients suffering from CRPS for 3.8 years in average still exhibit high pain, severity and kinesiophobia scores. Conclusions: Long-term deficits in strength and proprioceptive impairments are observed at the knee joint of the CRPS leg. This persistent functional disability has significant repercussions on the quality of life. We highlight the importance of including strength and proprioceptive exercises in the therapeutic approaches for CPRS patients. IMPLICATIONS FOR REHABILITATION The long-term evolution of patients suffering from lower-limb Complex Regional Pain Syndrome is associated with persistent disability, pain and impacts the quality of life. Strength, proprioceptive, functional and subjective assessments are necessary to better identify deficits. Rehabilitation should focus on the overall deficit of the affected and contralateral limb.
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NewsBot · Jun 15, 2020

MRI of Complex Regional Pain Syndrome in the Foot
Christoph A Agten et al
Eur J Radiol. 2020 May 6;129:109044.

Purpose: To evaluate the diagnostic potential of MRI in patients with suspected CRPS (complex regional pain syndrome).

Method: A retrospective health-record search was conducted for patients with suspected CRPS (foot). Fifty patients with initially suspected CRPS were included (37 females (51 ± 13 years) and 13 males (44 ± 15 years)). All patients underwent MRI. Two radiologists assessed skin, bone, and soft tissue parameters on MRI. The final diagnosis was CRPS (Gold standard: Budapest criteria) or non-CRPS. MRI parameters were compared between CRPS patients and non-CRPS patients.

Results: CRPS was diagnosed in 22/50(44 %) patients. Skin thickness (1.9 ± 0.5 mm vs. 1.7 ± 0.3 mm, p = 0.399), enhancement, and subcutaneous edema showed no differences between CRPS and non-CRPS patients. Bone marrow edema presence and pattern were not different between groups. Up to 50 % of CRPS patients showed no bone marrow edema. Subcortical enhancement and periosteal enhancement were not different between groups. For reader 1, muscle edema score was higher in the non-CRPS group compared to the CRPS group (0.1 ± 0.2 vs. 0.6 ± 1.0, p = 0.008), but not different for reader 2 (0.1 ± 0.5 vs. 0.2 ± 0.8, p = 0.819). Perfusion pattern was more extensive in non-CRPS patients for reader 1 (p = 0.048), but not for reader 2 (p = 0.157). Joint effusions showed no difference between groups.

Conclusions: MRI cannot distinguish between CRPS and non-CRPS patients. The role of MR imaging in patients with suspected CRPS is to exclude alternative diagnoses that would better explain patients' symptoms.
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NewsBot · Aug 5, 2021

Vitamin C prevention of complex regional pain syndrome after foot and ankle surgery: a prospective randomized study of three hundred and twenty nine patients
Jacques Hernigou et al
Int Orthop. 2021 Aug 4

Purpose: Complex regional pain syndrome (CRPS) after foot and ankle surgery has a significant impact on the ability to walk. As the symptomatic treatment of this disaster complication is poor and has low efficacy, a preventive treatment would be beneficial. Vitamin C has been reported to be efficient in preventing CRPS in elective scheduled surgery. Few authors explored this efficiency in foot and ankle surgery. We, therefore, evaluated the efficacy of vitamin C in preventing this complication after foot and ankle surgeries for both trauma and elective surgery.

Material and methods: Between January 2018 and December 2019, 329 patients were included in the study. We conducted a prospective randomized study on the efficiency of vitamin C (one group with and one without vitamin C) to prevent CRPS risk in patients operated in our institution on foot or ankle surgery. The incidence of CRPS after foot and ankle surgery was evaluated in both groups; the diagnostic of CRPS was made using the Budapest criteria associated with three-phase bone scintigraphy.

Results: Among the 329 patients included in the study (232 women and 97 men), 121 patients were included in the vitamin C group and 208 in the control group (without vitamin C). Vitamin C was statistically linked with a decreased risk of CRPS (OR 0.19; CI 95% from 0.05 to 0.8; p = 0.021). Alcoholism and cast immobilization were increased risks factors of CRPS (respectively p = 0.001 and p = 0.034).

Conclusion: Taking 1 g per day of vitamin C during 40 days after a foot or ankle surgery reduces the risk of CRPS.
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NewsBot · Aug 30, 2021

Going toe-to-toe with a rare case of a complex regional pain syndrome limited to the hallux
Audrey Wetzel-Weaver et al
BMJ Case Rep. 2021 Aug 25;14(8):e242781.

We report the first case of a complex regional pain syndrome (CRPS) limited to the hallux using the Budapest criteria. Limited forms of CRPS are scarce in the literature and probably overlooked. There is currently no consensus to define these forms. Due to the particular metameric topography, common to the hand and the foot, we suggest the term 'metameric' CRPS to describe them. A uniform nomenclature would promote future research to study its prevalence and specific treatment in more detail.
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NewsBot · Aug 2, 2022

The Management of Complex Regional Pain Syndrome-associated Foot Pain using a Poron Insole, a Sponge Upper Padding, and a Post-operative Shoe: A Case Report
Min Cheol Chang et al
Source

Background:
Pain from complex regional pain syndrome (CRPS) is frequently refractory to various treatment methods. Here, we present a case wherein foot pain from CRPS I was managed by applying an insole made from poron (a soft polyurethane foam and highly absorbent material for shock reduction), a sponge upper padding, and a post-operative shoe.

Case Presentation:
A 47-year-old female patient with CRPS I on her left foot complained of pain for a few months, which was aggravated while standing and walking [numeric rating scale (NRS): 8]. She had a history of a linear fracture in the distal portion of the left 1st metatarsal bone 5 months ago, and the pain from CRPS started 2 months after the fracture. We believed that the aggravated pain during standing and walking was allodynia. We utilized a poron insole, a sponge upper padding, and a post-operative shoe to reduce the pressure and friction loading on her left foot. 1 month after this intervention, the patients’ pain during standing and walking was found to have reduced from NRS 8 to NRS 3. At her 3- and 6-month follow-ups, the degree of pain was sustained at NRS 3.

Conclusion:
We believe that the reduction of allodynia using materials, which can absorb mechanical pressure and friction of the foot, can help manage pain from CRPS.
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NewsBot · Nov 20, 2023

Traditional Chinese medicine for foot pain in a patient with complex regional pain syndrome: A case report
Woo-Chul Shin et al
World J Clin Cases. 2023 Oct 26;11(30):7424-7431. doi: 10.12998/wjcc.v11.i30.7424.

Background: Complex regional pain syndrome (CRPS) is characterized by pain as well as sensory, motor, and sudomotor disorders. Generally, it is classified into two types CRPS-I and CRPS-II. There is no single diagnostic test or treatment approach for CRPS, and a multidisciplinary approach is gaining attention to improve patients' symptoms and their quality of life.

Case summary: A 35-year-old woman with an unremarkable medical history sought treatment for CRPS at a hospital of Korean medicine. During her first visit, she was wheelchair-bound due to severe pain in her left lower extremity. She had edema and discoloration of the left foot. She was treated with a combination of traditional Chinese medicine (TCM) approaches, including acupuncture, moxibustion, pharmacopuncture, and herbal decoction, for approximately 20 sessions. The foot and ankle outcome score (FAOS) and visual analog scale (VAS) score for pain were evaluated, along with general signs and functions. Her symptoms, signs, FAOS, and VAS scores improved after treatment, with a significant 7-degree decrease in the VAS score and a 62-point increase in the FAOS score. Additionally, the foot swelling and discoloration gradually resolved. During the phone follow-up, 5 mo after the last visit, additional improvements in outcomes were observed.

Conclusion: Combined TCM treatment may be a reasonable and safe option for alleviating symptoms and improving function in patients with CRPS.
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