Summary
Introduction: Complex regional pain syndrome (CRPS) is a relatively rare disorder, but one that
is extremely serious for the affected patient. It usually occurs in the area distal
to a primary limb injury. The clinical symptoms and the pain are out of all proportion
to the inciting event and in approximately 10 % of CRPS patients, there is no triggering
event at all. CRPS leads to long-term disability and high treatment and follow-up
costs In about half of those affected.
Clinical symptoms: Two forms exist. In CRPS type 1, no nerve lesions are present,
whereas in CRPS type 2, injury has occurred to a nerve or the main branch of a nerve.
However, in terms of their clinical course, there is no difference between the two
forms. Approximately 90 % of all cases involve CRPS type 1, formerly known as “Sudeck’s
atrophy”. The cardinal symptom is pain. In addition, trophic disturbances, such as
swelling, local skin discolouration or asymmetric skin temperatures, can also occur.
Impaired mobility and function of the affected limb also occur frequently and are
very difficult to treat.
Diagnosis: Initially, it can be difficult to distinguish between CRPS and a normal post-traumatic
course. Subsequently, the severe symptoms are out of all proportion to the inciting
event. The diagnosis of CRPS is based mainly on the clinical symptoms. The Budapest
criteria help to confirm the diagnosis.
Therapy: Early and interdisciplinary rehabilitation is of crucial importance in CRPS treatment.
Occupational therapy and physiotherapy are supplemented by good analgesic management
and psychological support, if required. Analgesia should be based on the WHO pain
ladder. Methadone is of proven efficacy in cases of severe hyperalgesia and gabapentin
or pregabalin are used to treat refractory pain. Bisphosphonates have shown a good
analgesic effect, particularly in patients with confirmed bone lesions. Chronic oedema
and inflammation may require short-term steroid administration. A further clinical
goal is the avoidance of sequelae, such as osteoporosis. Patients with suspected CRPS
should be referred to a multidisciplinary treatment team, preferably one with considerable
experience in treating this clinical presentation. One physician should coordinate
the patient’s treatment. The earlier the treatment is started, the better the prognosis.
Keywords
Complex regional pain syndrome - CRPS - Sudeck’s atrophy
