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December 3, 2014

Complex regional pain syndrome
An optimistic perspective

January 6, 2015 issue
84 (1) 89-96

Abstract

Complex regional pain syndrome (CRPS) presents with clinical symptoms that can no longer be explained by the initial trauma, including pain, sensory, motor, and trophic symptoms, and impairment of autonomic control of the limb. These symptoms spread distally and go beyond single nerve innervation territories. Typically, the symptoms change through the course of CRPS as a result of the varying pathophysiology. Diagnosis is made clinically after the rigorous elimination of other possible causes, and 3-phase bone scintigraphy can be a useful tool for confirming CRPS. In acute stages, inflammatory symptoms prevail and should be treated with anti-inflammatory agents (steroids), bisphosphonates, or topical application of dimethyl sulfoxide. In chronic stages, many symptoms are related to so-called central neuroplasticity; these include hyperalgesia, sensory loss, motor symptoms, body perception disturbance, autonomic symptoms, and learned incorrect behavior such as nonuse. At this stage, the only medical treatment that is effective against pain without improving the function is ketamine infusions, but this has side effects. Physical therapy, graded motor imagery, and pain exposure/graded exposure in vivo therapy can help to overcome central reorganization. If a relevant mental comorbidity is present, the patient should be referred for psychotherapeutic treatment. Invasive treatment should be restricted to special cases and only offered after psychosomatic assessment. If these recommendations are followed, CRPS prognosis is not as poor as commonly assumed. Whether the patients can return to their previous life depends on particular individual factors.

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Information & Authors

Information

Published In

Neurology®
Volume 84Number 1January 6, 2015
Pages: 89-96
PubMed: 25471395

Publication History

Received: March 19, 2014
Accepted: July 25, 2014
Published online: December 3, 2014
Published in print: January 6, 2015

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Disclosure

F. Birklein received institutional grants from the German Research Foundation, the European Union FP7 health program, the Foundation Rhineland Palatinate for Innovation, the nonprofit Hopp-Foundation, the NHMRC Australia, and an unrestricted educational grant from Lilly Germany. Prof. Birklein received speaker honoraria and consultant fees from Astellas, Lilly Germany, Desitin, and Pfizer Germany. D. O'Neill reports no disclosures relevant to the manuscript. T. Schlereth received intramural institutional grants from the University Medical Centre Mainz. Go to Neurology.org for full disclosures.

Study Funding

Supported by the Foundation Rhineland-Palatinate, the DFG Bi 579/8-1, the European Union EU-FP7 ncRNAPain grant 602133, the Dietmar Hopp Foundation, and the NHMRC Australia.

Authors

Affiliations & Disclosures

Frank Birklein, MD*
From the Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131 Mainz.
Disclosure
Scientific Advisory Boards:
1.
Lilly, advisor, ongoing Pfizer, advisor, ongoing Astellas, advisor, ongoing
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
Neurology, ed board, ongoing European Journal of Pain, field editor, ongoing Pain Medidicin, ed board, onggingThe Open Neurology Journal, ed board, ongoing
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
Lilly Germany,F1J-SB_0041
Research Support, Government Entities:
1.
German Research Foundation, Graduate School Neurowissenschaften Foundation Innovation Rheinland-Pfalz, Project 936 NHMRC Australia, APP1030379 European Union EU, FP7, ncRNAPain; grant 602133
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Darragh O'Neill, PhD*
From the Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131 Mainz.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Tanja Schlereth, MD*
From the Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131 Mainz.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE

Notes

Correspondence to Dr. Birklein: [email protected]
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
*
All authors contributed equally to this work.

Author Contributions

Dr. Birklein: study concept and design, analysis and interpretation, study supervision. Dr. O'Neill: analysis and interpretation, critical revision of the manuscript. Dr. Schlereth: study concept and design, analysis and interpretation.

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