Concise Review for CliniciansComplex Regional Pain Syndrome
Section snippets
DIAGNOSIS
No specific test is available for CRPS, and no pathognomonic clinical feature identifies this condition. Rather, identifying a constellation of history, clinical examination, and supporting laboratory findings make the diagnosis. Complex regional pain syndrome can occur in children and adults.3
CLINICAL HISTORY AND PHYSICAL EXAMINATION FINDINGS
Most patients with CRPS have an identifiable inciting or initiating injury, which may be trivial, such as a minor limb sprain, or severe, such as trauma involving a major nerve or nerves. The key features are pain, allodynia and hyperalgesia, abnormal vasomotor activity, and abnormal sudomotor activity persisting beyond the period of normal healing. Allodynia is defined as a disproportionately increased pain response to a nonnoxious stimulus. Hyperalgesia is defined as a disproportionately
DIAGNOSTIC TESTING
Although no specific diagnostic test is available for CRPS, several tests can be supportive in making the diagnosis, but the most important role of testing is to help rule out other conditions. Vascular studies to rule out a vascular etiology are indicated when vasomotor signs and symptoms are prominent. Electrodiagnostic studies may be indicated to rule out specific neuropathic conditions, such as peripheral neuropathy, entrapment neuropathies, or nerve injury. Radiographic studies including
TREATMENT
The selection of a specific technique or a combination of techniques depends on the severity of symptoms and the degree of disability. Of importance, successful treatment of CRPS depends on an aggressive and multidisciplinary approach. Since pain and limb dysfunction are the major clinical problems, physical rehabilitation and pain control are the main treatment objectives. The selection of pain management modalities is guided by the severity of the pain and the presence or absence of
CONCLUSION
Like most medical conditions, early diagnosis and treatment of CRPS increase the likelihood of a successful outcome. Accordingly, patients with clinical signs and symptoms of CRPS after an injury should be referred as soon as possible to a physician with expertise in evaluating and treating this condition. Mild cases respond to physical therapy and physical modalities. Mild to moderate cases may require adjuvant analgesics, such as gabapentin and/or an antidepressant medication. An opioid
Questions About CRPS
- 1.
Which one of the following is not included in the criteria for the diagnosis of CRPS?
- a.
Pain that develops after an initial painful event that may or may not have been traumatic
- b.
Distribution of the painful area is limited to the distribution of a single peripheral nerve
- c.
History of edema, skin blood flow abnormalities, or sudomotor abnormalities in the painful region
- d.
No other concomitant conditions account for the pain
- e.
Allodynia, hyperalgesia, or spontaneous pain is present
- a.
- 2.
Which one of the
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Cited by (0)
Dr Brewer is now at Duke University, Durham, NC
A question-and-answer section appears at the end of this article.