Pharmacological and Non-pharmacological Treatment for Complex Regional Pain Syndrome (CRPS): A Review
Abstract
Complex regional pain syndrome (CRPS), previously known as reflex sympathetic dystrophy (RSD) or causalgia, is a chronic debilitating neurological disorder characterized by limb pain, that can be developed after a minor trauma, fractures or lesions of the peripheral or central nervous system. The prevalence of CRPS is relatively low; and the symptoms of this dynamic disease are distinct among different patients. No specific diagnostic test is available and hence diagnosis is mainly relied on clinical examination and supportive laboratory findings. Also, since the symptoms are individual-specific, there exist no single drug which is effective globally among the patient community. An early recognition, prompt initiation and a multidisciplinary approach including pharmacological, rehabilitation and psychological therapies seems to be effective in treating CRPS, to obtain an optimum outcome. This review encompasses recent advances in the treatment strategies – medical and non-medical – employed in the management of CRPS.
Keywords:
causalgia, complex regional pain syndrome, CRPS, reflex sympathetic dystrophy, Sudeck’s atrophy, pain
References
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13. Leriche R, De la causalgie envisagee comme une nevrite due sympathique et de son traitment par la denudation et l’excision des plexus nerveux peri-arteriels. Presse Medicale. 1916; 24:178–80.
14. Evans JA, Reflex sympathetic dystrophy, Surg Clin North Am. 1946 Jun; 26:780-90.
15. Stanton HM, Complex regional pain syndrome (Type I, RSD; Type II, causalgia): controversies. Clin J Pain. 2000; 16:S33–40.
16. Griepp M, A follow-up study of 14 young adults with complex regional pain syndrome type I. J Neurol Assoc. 2000; 48:49–59.
17. Dellemijn PL, The interpretation of pain relief and sensory changes following sympathetic blockade. Brain 1994; 117 (Pt 6):1475-1487.
18. Atalay NS, Ercidogan O, Akkaya N, Sahin F. Prednisolone in complex regional pain syndrome. Pain Physician 2014; 17 (2): 179-85.
19. Barbalinarrdo S, Loer SA, Goebel A, Perez RS. The treatment of longstanding complex regional pain syndrome with oral steroids. Pain Med. [Epub 7 Dec 2015].
20. Christensen K, Jensen EM, Noer I. The reflex dystrophy syndrome response to treatment with corticosteroids. Acta Chir Scand 1982; 148:653-655.
21. Braus DF, Kraus JK, Strobel J. The shoulder-hand syndrome after stroke: A prospective clinical trial. Ann Neurol 1994; 36:728-33.
22. Manicourt DH, Brassseur JP, Boutsen Y, Depreseux G, Devogeleur JP. Role of alendronate in therapy for posttraumatic complex regional pain syndrome type I of the lower extremity. Arthritis Rheum 2004;50:3690-3697.
23. Varenna M, Zucchi F, Ghiringhelli D,Binelli L, Bevilacqua M, Bettica P, Sinigaglia L. Intravenous codranate in the treatment of reflex sympathetic dystrophy syndrome. A randomized double blind, placebo controlled study. J Rheumatol 2000; 27:1477-1483.
24. Robinson JN, Sandom J, Chapman PT. Efficacy of pamindrate in complex regional pain syndrome type I. Pain Med 2004;5:276-280.
25. Braga PC. Calcitonin and its antinociceptive activity: Animal and human investigations 1975-1992.Agents Actions 1994; 41:121-31.
26. Gobelet C, waldburger M, Meier JL. The effect of adding calcitonin to physical treatment on reflex sympathetic dystrophy. Pain 1992; 48:171-175.
27. Bickerstaff DR, Kanis JA. The use of nasal calcitonin in the treatment of post-traumatic algodystrophy. B r J Rheumatol 1991; 30:291-294.
28. Attal N, Brasseur L,Chauvin M,Bouhassira D. Effects of single and repeated applications of a eutetic mixture of local anaesthetics (EMLA) cream on spontaneous and evoked pain in post-herpetic neuralgia. Pain 1999; 81:203-9.
29. Rho RH, Complex regional pain syndrome. Mayo Clin Proc 2002; 77:174-180.
30. Rowbhotham MC. Pharmacologic management of complex regional pain syndrome. Clin J Pain 2006; 22:425-429.
31. Stanton HM, Complex regional pain syndrome’s: guidelines for therapy.Clin J Pain 1998; 14:155-166.
32. Backonja MM. Anticonvulsants (antineuropathics) for neuropathic pain syndromes. Clin J Pain 2000; 16:S67-S72.
33. Backonja MM, Sera Pharmacologic management part 2: lesser –studies neuropathic pain diseases. Pain Med 2004; 5:S48-S59.
34. Van de Vusse AC. Randomised controlled trial of gabapentin in complex regional pain syndrome type I, BMC Neurol. 2004;4:13-23.
35. Serpell MG. Gabapentin in neuropathic pain syndromes: a randomised, double-blind, placebo-controlled trial. Pain 2002; 99:557-566.
36. Moseley GL, Pain 108 (2004) 192–198.
37. Perez RS, et al. The treatment of complex regional pain syndrome type I with free radical scavengers: a randomized controlled study. Pain 2003; 102:297-307.
38. Manchikanti L. The role of radiofrequency in the management of complex regional pain syndrome.Curr Rev Pain 2000; 4:437-444.
39. Singh B. Sympathectomy for complex regional pain syndrome. J Vasc Surg. 2003; 37:508-511.
40. Nelson DV, Stacey BR. Interventional therapies in the management of complex regional pain syndrome. Clin J Pain 2006; 22:438-442.
41. Haynsworth RF, Noe CE,. Percutaneous lumbar sympathectomy: a comparison of radiofrequency denervation versus phenol neurolysis. Anesthesiolkogy 1991; 74:459-463.
42. Olcott C, Lorne G, et al. Reflex sympathetic dystrophy - The surgeon’s role in management. J Vasc Surg. 1991; 14:488-495.
43. Gordon A, Zechmeister K, Collin J. The role of sympathectomy in current surgical practice. Eur J Vasc Surg 1994; 8:129-137.
44. Aburahma A, Robinson P, et al. Sympathectomy for reflex sympathetic dystrophy: Factors affecting outcome. Ann Vasc Surg 1994; 8:372-379.
45. Ahn S, Machleder H, et al. Thoracoscopic cervicodorsal sympathectomy: preliminary results. J Vasc Surg 1994; 20:511-519.
46. Janig W, Stanton-Hicks M, eds. Reflex sympathetic dystrophy: A reappraisal. Progress in Pain Research and Management. Volume 6, Seattle: IASP Press. 1996.
47. Kramis R, Roberts G, Gillet R. Post-sympathectomy neuralgia: hypothesis on peripheral and central neuronal mechanisms. Pain 1996 ; 64:1-9.
48. Kingery WS. A critical review of controlled clinical trials for peripheral neuropathic pain and complex regional pain syndromes. Pain 1997; 73:123-139.
49. Kemler MA, et al. Spinal cord stimulation in patients with chronic reflex sympathetic dystrophy. N Engl J Med. 2000; 343:618-624.
50. Lee KJ, Kirchner JS. Complex regional pain syndrome and chronic pain management iin the lower extremity. Foot Ankle Clin 2002; 7:409-419.
51. Mailis-Gagnon A, Spinal cord stimulation for chronic pain. Cochrane Database Syst Rev 2004.CD003783.
52. Robaina F, Dominguez M, Spinal cord stimulation for relief of chronic pain in vasospastic disorders of the upper limbs. Neurosurgery 1989; 24:63-67.
53. Broseta J, Roldan P, Chronic epidural dorsal column stimulation in the treatment of causalgic pain. Appl Neurophysiol 1982; 45:190-194.
54. Barolat G, Schwartzman R, et al. Epidural spinal cord stimulation in the management of reflex sympathetic dystrophy. Stereotact Funct Neurosurg 1989; 53:29-39.
55. Law J, Kirkpatrick A. Update: Spinal cord stimulation. Am J Pain Manag 1992; 2:39-42.
56. Mailis-Gagnon A, Spinal cord stimulation for chronic pain. Cochrane Database Syst Rev 2004.CD003783.
57. Bruehl S, Husfeldt B, et al. Psychological differences between reflex sympathetic dystrophy and non-RSD chronic pain patients. Pain 1996; 67: 107-114.
58. Ciconne D, Bandilla E, Wu W. Psychological dysfunction in patients with reflex sympathetic dystrophy. Pain 1997; 71:323-33.
59. Bruehl S, Chung OY. Psychological and behavioural aspects of complex regional pain syndrome management. Clin J Pain 2006; 22:430.
60. Priganc VW, Stralka SW. Graded Motor Imagery. Jour of Hand Therapy. 2011; 24:164-169.
61. 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. Rheum. 2003; 42:97-101.
62. Bowering KJ, O’Connell NE, Tabor A, The effects of graded motor imagery and its components on chronic pain: a systematic review and meta-analysis. The J. of Pain. 2013; 14 (1):3-13.
63. De Jong JR, Vlaeyen JWS, Onghena P, Cuypers C, Den Hollander M, Ruijgrok J. Reduction of pain-related fear in complex regional pain syndrome type I: The application of graded exposure in vivo. Pain 2005a; 116: 264-275.
64. De Jong JR, Vlaeyen JWS, Onghena P, Goossens MEJB, Geilen M, Mulder H. Fear of movement/(re)injury in chronic low back pain: Education or exposure in vivo as mediator to fear reduction? Clin J Pain 2005b; 21: 9–17.
2. International Association for the Study of Pain. Classification of chronic pain, 2nd edition (2012).
3. Bruehl S. Complex regional pain syndrome. BMJ. 2015; 35(1):27-30.
4. Bruehl S, Chung OY: Complex regional pain syndrome, Encyclopaedia of the Neurological Sciences. Edited by Aminoff MJ, Daroff RB. San Diego, Academic Press, 2003, pp 749-754.
5. Evans JA., Reflex sympathetic dystrophy. Surg Clin North Am 1946; 26:435-448.
6. Merskey H, Bogduk N. Classifications of chronic pain: Description of chronic pain syndromes and definition of pain terms. Report by the International Association for the Study of Pain Task Force on Taxonomy. In: Merskey H, Bogduk N, editors. Seattle: IASP Press; 1994.
7. Li Z, Smith BP, Tuohy C, Smith TL, Andrew Koman L. Complex regional pain syndrome after hand surgery. Hand Clin. 2010; 26:281–289.
8. Ambrosie Paré, Of the Cure of Wounds of the Nervous System. The Collected Works of Ambroise Pare; Milford House, New York: 1634-1639
9. Denmark, A, An Example of Symptoms resembling Tic Douleureux, produced by a wound in the Radial Nerve. Med Chir Trans. 1813; 4:48–52.
10. Mitchell SW, Morehouse GR, Keen WW, Gunshot Wounds and Other Injuries of Nerves. JB Lippincott; Philadelphia: 1864
11. Mitchell SW. Injuries of nerves and their consequences. JB Lippincott; Philadelphia: 1872.
12. Sudeck P, Über die akute entzündliche Knochenatrophie. Arch Klin Chir. 1900; 62:147–56.
13. Leriche R, De la causalgie envisagee comme une nevrite due sympathique et de son traitment par la denudation et l’excision des plexus nerveux peri-arteriels. Presse Medicale. 1916; 24:178–80.
14. Evans JA, Reflex sympathetic dystrophy, Surg Clin North Am. 1946 Jun; 26:780-90.
15. Stanton HM, Complex regional pain syndrome (Type I, RSD; Type II, causalgia): controversies. Clin J Pain. 2000; 16:S33–40.
16. Griepp M, A follow-up study of 14 young adults with complex regional pain syndrome type I. J Neurol Assoc. 2000; 48:49–59.
17. Dellemijn PL, The interpretation of pain relief and sensory changes following sympathetic blockade. Brain 1994; 117 (Pt 6):1475-1487.
18. Atalay NS, Ercidogan O, Akkaya N, Sahin F. Prednisolone in complex regional pain syndrome. Pain Physician 2014; 17 (2): 179-85.
19. Barbalinarrdo S, Loer SA, Goebel A, Perez RS. The treatment of longstanding complex regional pain syndrome with oral steroids. Pain Med. [Epub 7 Dec 2015].
20. Christensen K, Jensen EM, Noer I. The reflex dystrophy syndrome response to treatment with corticosteroids. Acta Chir Scand 1982; 148:653-655.
21. Braus DF, Kraus JK, Strobel J. The shoulder-hand syndrome after stroke: A prospective clinical trial. Ann Neurol 1994; 36:728-33.
22. Manicourt DH, Brassseur JP, Boutsen Y, Depreseux G, Devogeleur JP. Role of alendronate in therapy for posttraumatic complex regional pain syndrome type I of the lower extremity. Arthritis Rheum 2004;50:3690-3697.
23. Varenna M, Zucchi F, Ghiringhelli D,Binelli L, Bevilacqua M, Bettica P, Sinigaglia L. Intravenous codranate in the treatment of reflex sympathetic dystrophy syndrome. A randomized double blind, placebo controlled study. J Rheumatol 2000; 27:1477-1483.
24. Robinson JN, Sandom J, Chapman PT. Efficacy of pamindrate in complex regional pain syndrome type I. Pain Med 2004;5:276-280.
25. Braga PC. Calcitonin and its antinociceptive activity: Animal and human investigations 1975-1992.Agents Actions 1994; 41:121-31.
26. Gobelet C, waldburger M, Meier JL. The effect of adding calcitonin to physical treatment on reflex sympathetic dystrophy. Pain 1992; 48:171-175.
27. Bickerstaff DR, Kanis JA. The use of nasal calcitonin in the treatment of post-traumatic algodystrophy. B r J Rheumatol 1991; 30:291-294.
28. Attal N, Brasseur L,Chauvin M,Bouhassira D. Effects of single and repeated applications of a eutetic mixture of local anaesthetics (EMLA) cream on spontaneous and evoked pain in post-herpetic neuralgia. Pain 1999; 81:203-9.
29. Rho RH, Complex regional pain syndrome. Mayo Clin Proc 2002; 77:174-180.
30. Rowbhotham MC. Pharmacologic management of complex regional pain syndrome. Clin J Pain 2006; 22:425-429.
31. Stanton HM, Complex regional pain syndrome’s: guidelines for therapy.Clin J Pain 1998; 14:155-166.
32. Backonja MM. Anticonvulsants (antineuropathics) for neuropathic pain syndromes. Clin J Pain 2000; 16:S67-S72.
33. Backonja MM, Sera Pharmacologic management part 2: lesser –studies neuropathic pain diseases. Pain Med 2004; 5:S48-S59.
34. Van de Vusse AC. Randomised controlled trial of gabapentin in complex regional pain syndrome type I, BMC Neurol. 2004;4:13-23.
35. Serpell MG. Gabapentin in neuropathic pain syndromes: a randomised, double-blind, placebo-controlled trial. Pain 2002; 99:557-566.
36. Moseley GL, Pain 108 (2004) 192–198.
37. Perez RS, et al. The treatment of complex regional pain syndrome type I with free radical scavengers: a randomized controlled study. Pain 2003; 102:297-307.
38. Manchikanti L. The role of radiofrequency in the management of complex regional pain syndrome.Curr Rev Pain 2000; 4:437-444.
39. Singh B. Sympathectomy for complex regional pain syndrome. J Vasc Surg. 2003; 37:508-511.
40. Nelson DV, Stacey BR. Interventional therapies in the management of complex regional pain syndrome. Clin J Pain 2006; 22:438-442.
41. Haynsworth RF, Noe CE,. Percutaneous lumbar sympathectomy: a comparison of radiofrequency denervation versus phenol neurolysis. Anesthesiolkogy 1991; 74:459-463.
42. Olcott C, Lorne G, et al. Reflex sympathetic dystrophy - The surgeon’s role in management. J Vasc Surg. 1991; 14:488-495.
43. Gordon A, Zechmeister K, Collin J. The role of sympathectomy in current surgical practice. Eur J Vasc Surg 1994; 8:129-137.
44. Aburahma A, Robinson P, et al. Sympathectomy for reflex sympathetic dystrophy: Factors affecting outcome. Ann Vasc Surg 1994; 8:372-379.
45. Ahn S, Machleder H, et al. Thoracoscopic cervicodorsal sympathectomy: preliminary results. J Vasc Surg 1994; 20:511-519.
46. Janig W, Stanton-Hicks M, eds. Reflex sympathetic dystrophy: A reappraisal. Progress in Pain Research and Management. Volume 6, Seattle: IASP Press. 1996.
47. Kramis R, Roberts G, Gillet R. Post-sympathectomy neuralgia: hypothesis on peripheral and central neuronal mechanisms. Pain 1996 ; 64:1-9.
48. Kingery WS. A critical review of controlled clinical trials for peripheral neuropathic pain and complex regional pain syndromes. Pain 1997; 73:123-139.
49. Kemler MA, et al. Spinal cord stimulation in patients with chronic reflex sympathetic dystrophy. N Engl J Med. 2000; 343:618-624.
50. Lee KJ, Kirchner JS. Complex regional pain syndrome and chronic pain management iin the lower extremity. Foot Ankle Clin 2002; 7:409-419.
51. Mailis-Gagnon A, Spinal cord stimulation for chronic pain. Cochrane Database Syst Rev 2004.CD003783.
52. Robaina F, Dominguez M, Spinal cord stimulation for relief of chronic pain in vasospastic disorders of the upper limbs. Neurosurgery 1989; 24:63-67.
53. Broseta J, Roldan P, Chronic epidural dorsal column stimulation in the treatment of causalgic pain. Appl Neurophysiol 1982; 45:190-194.
54. Barolat G, Schwartzman R, et al. Epidural spinal cord stimulation in the management of reflex sympathetic dystrophy. Stereotact Funct Neurosurg 1989; 53:29-39.
55. Law J, Kirkpatrick A. Update: Spinal cord stimulation. Am J Pain Manag 1992; 2:39-42.
56. Mailis-Gagnon A, Spinal cord stimulation for chronic pain. Cochrane Database Syst Rev 2004.CD003783.
57. Bruehl S, Husfeldt B, et al. Psychological differences between reflex sympathetic dystrophy and non-RSD chronic pain patients. Pain 1996; 67: 107-114.
58. Ciconne D, Bandilla E, Wu W. Psychological dysfunction in patients with reflex sympathetic dystrophy. Pain 1997; 71:323-33.
59. Bruehl S, Chung OY. Psychological and behavioural aspects of complex regional pain syndrome management. Clin J Pain 2006; 22:430.
60. Priganc VW, Stralka SW. Graded Motor Imagery. Jour of Hand Therapy. 2011; 24:164-169.
61. 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. Rheum. 2003; 42:97-101.
62. Bowering KJ, O’Connell NE, Tabor A, The effects of graded motor imagery and its components on chronic pain: a systematic review and meta-analysis. The J. of Pain. 2013; 14 (1):3-13.
63. De Jong JR, Vlaeyen JWS, Onghena P, Cuypers C, Den Hollander M, Ruijgrok J. Reduction of pain-related fear in complex regional pain syndrome type I: The application of graded exposure in vivo. Pain 2005a; 116: 264-275.
64. De Jong JR, Vlaeyen JWS, Onghena P, Goossens MEJB, Geilen M, Mulder H. Fear of movement/(re)injury in chronic low back pain: Education or exposure in vivo as mediator to fear reduction? Clin J Pain 2005b; 21: 9–17.
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How to Cite
V, M. “Pharmacological and Non-Pharmacological Treatment for Complex Regional Pain Syndrome (CRPS): A Review”. Current Research in Pharmaceutical Sciences, Vol. 7, no. 4, Jan. 2018, pp. 101-8, doi:10.24092/CRPS.2017.070401.
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