The association between psychological factors and the development of complex regional pain syndrome type 1 (CRPS1)--a prospective multicenter study

Complex regional pain syndrome involving the face following snowball injury

Complex regional pain syndrome (CRPS) is a condition of unknown etiology characterized by autonomic, sensory, and motor disturbance. CRPS usually follows an injury in the affected limb, which is often trivial in nature. CRPS involving the facial region is rare, and there have been no previous descriptions in children. We describe a 13-year-old girl with CRPS involving the face, which developed after being struck by a snowball. The clinical characteristics were similar to those of CRPS elsewhere in the body involving burning pain, hyperalgesia, and hyperesthesia. This was later accompanied by skin edema, fluctuating color, and temperature changes, as well as loss of eyebrow hair. Following detailed but inconclusive investigations, a clinical diagnosis of CRPS was made in line with Budapest diagnostic criteria. Over the next year, her condition gradually improved with ongoing comprehensive multidisciplinary input. We present this patient to alert clinicians to consider CRPS in the differential diagnosis of similar cases who present with chronic facial pain and skin changes.

Perioperative factors affecting the occurrence of acute complex regional pain syndrome following limb bone fracture surgery: data from the Japanese Diagnosis Procedure Combination database

OBJECTIVE

Complex regional pain syndrome (CRPS) describes a broad spectrum of symptoms that predominantly localize to the extremities. Although limb fracture is one of the most frequently reported triggering events, few large-scale studies have shown the occurrence of and factors associated with CRPS following limb fracture. This study aimed to show the occurrence and identify of those factors.

METHODS

Using the Japanese Diagnosis Procedure Combination database, we identified 39 patients diagnosed with CRPS immediately after open reduction and internal fixation (ORIF) for limb fracture from a cohort of 185 378 inpatients treated with ORIF between 1 July and 31 December of each year between 2007 and 2010. Patient and clinical characteristics such as age, gender, fracture site, duration of anaesthesia and use of regional anaesthesia were investigated by logistic regression analyses to examine associations between these factors and the in-hospital occurrence of CRPS after ORIF.

RESULTS

The occurrence of CRPS was relatively high in fractures of the distal forearm, but low in fractures of the lower limb and in patients with multiple fractures. Generally females are considered to be at high risk of CRPS; however, we found a comparable number of male and female patients suffering from CRPS after ORIF for limb fracture. In terms of perioperative factors, a longer duration of anaesthesia, but not regional anaesthesia, was significantly associated with a higher incidence of CRPS.

CONCLUSION

Although a limited number of CRPS patients were analysed in this study, reduced operative time might help to prevent the development of acute CRPS following limb fracture.

Rehabilitation of complex regional pain syndrome: evidence based or trial and error?

SUMMARY Complex regional pain syndrome (CRPS), a relatively rare condition, is commonly diagnosed late and has no known cause or cure. There is a limited evidence base for therapeutic interventions and the majority of patients make a spontaneous recovery. The florid signs and symptoms of early CRPS are diminished and altered in the more persistent treatment-resistant form. New signs and symptoms, not listed in diagnostic criteria, begin to emerge that can confuse both the patient and clinician, and lead to questioning of the diagnosis. Trying to implement timely and evidence-based rehabilitation techniques within the above scenario is a significant challenge. This article will discuss those challenges and consider recent clinical and research advances that have sought to address some of these problems in CRPS type I.

Management of adult patients with long-standing complex regional pain syndrome

SUMMARY Approximately 15% of patients with complex regional pain syndrome will experience no improvement in their condition within the first 12 months. This group should be considered as having a long-term condition. Recently published clinical studies and national guidelines can support clinicians to devise rational approaches to the management of this group; however, conclusive evidence is still lacking for almost all aspects of care. A multidisciplinary approach to managing long-standing complex regional pain syndrome appears best suited to ensure high-quality care. This should allow effective functional rehabilitation. Unfortunately, however, meaningful pain relief is often not achieved with currently available treatment methods. Recently published novel treatment approaches will probably provide more patients with long-term pain relief in the future, but confirmatory trials are required.

Complex regional pain syndrome in children: asking the right questions

BACKGROUND

Complex regional pain syndrome (CRPS) is a painful disorder without a known unifying mechanism. There are little data on which to base evaluation and treatment decisions, and what data are available come from studies involving adults; however, even that literature is relatively sparse. Developing robust research for CRPS in children is essential for the progress toward optimal treatment.

OBJECTIVES

To determine potential avenues of research in pediatric CRPS based on a review of the literature. Areas of concern include diagnostic criteria, peripheral mechanisms, central nervous system mechanisms, the role of the autonomic nervous system, possible risk factors, options for prevention and potential avenues of treatment.

METHODS

A literature review was performed and the results applied to form the hypotheses posited in the form of research questions.

RESULTS AND CONCLUSIONS

CRPS is a complicated entity that is more than a painful sensory condition. There is evidence for peripheral inflammatory and neurological changes, and reorganization in both sensory and motor cortexes. In addition, a significant motor component is frequently observed and there appear to be tangible risk factors. Many of these pieces of evidence suggest options for prevention, treatment and monitoring progress and outcome. Most of the data are derived from adult studies and need to be replicated in children. Furthermore, there may be factors unique to pediatrics due to developmental changes in neuroplasticity as well as somatic, endocrinological and emotional growth. Some of these developmental factors may shed light on the adult condition.

Medically unexplained symptoms and pain: misunderstanding and myth

PURPOSE OF REVIEW

The recent resurgence of the notion of psychosomatic disorders, grouping together as 'medically unexplained symptoms' all those without organic diagnosis and associated with distress, has included all chronic (persistent) pain within its remit. As pain is reasonably well explained, within an integrated biopsychosocial model, critical analysis of the position is required.

RECENT FINDINGS

Neuroscientific and translational studies of pain mechanisms have strengthened the understanding of pain, providing stronger connections between abstract psychological concepts corresponding to observation and studies of human clinical populations, neuroscientific findings in clinical and analogue studies, and animal research. This situation is contrasted with even the most recent reviews of medically unexplained symptoms providing only vague and patchily supported mechanisms, with little cognate human analogue or animal research.

SUMMARY

The implication of subsuming chronic pain under medically unexplained symptoms is that the primary care/community physician will try to persuade the patient that the symptoms indicate underlying depression, which her or she may offer to treat. When pain is instead recognized as a problem in its own right, it would be referred for specialist opinion and care, or treated directly with evidence-based pain interventions.

Still's Disease and Recurrent Complex Regional Pain Syndrome Type-I: The First Description

Complex regional pain syndrome (CRPS) is a chronic neuropathic pain disorder characterized by neuropathic pain associated with local edema and changes suggestive of autonomic involvement such as altered sweating, skin color, and skin temperature of the affected region. CRPS was described associated with several diseases, such as trauma, psychiatric conditions, and cancer. However, no case associated with Still's disease has been previously described. In this paper, the authors describe the first case of CRPS associated with Still's disease.

Clinical features and pathophysiology of complex regional pain syndrome

A complex regional pain syndrome (CRPS)--multiple system dysfunction, severe and often chronic pain, and disability--can be triggered by a minor injury, a fact that has fascinated scientists and perplexed clinicians for decades. However, substantial advances across several medical disciplines have recently improved our understanding of CRPS. Compelling evidence implicates biological pathways that underlie aberrant inflammation, vasomotor dysfunction, and maladaptive neuroplasticity in the clinical features of CRPS. Collectively, the evidence points to CRPS being a multifactorial disorder that is associated with an aberrant host response to tissue injury. Variation in susceptibility to perturbed regulation of any of the underlying biological pathways probably accounts for the clinical heterogeneity of CRPS.