Page 261 Guide to Pain Management in Low-Resource Settings

Chapter 33

Complex Regional Pain Syndrome

Andreas Schwarzer and Christoph Maier

In 1865, the neurologist Silas Weir Mitchell reported single nerve, e.g., the whole hand is aff ected following
about soldiers complaining of strong burning pain, pro- fracture of the radius; (3) usually both joints and nerves
nounced hyperesthesia, edema, and reduction of motor are aff ected; (4) patients often present with psychological
function of the limb following injuries of the upper or disturbances. Th ere are no clinical diff erences between
lower extremity. Mitchell named these disturbances “cau- CRPS type I and type II; except for the nerve damage.
salgia.” In the following years, these symptoms were de-
scribed again and again after extremity injuries but were What is the incidence of CRPS, and
labeled diff erently (algodystrophy, refl ex sympathetic dys- are there specifi c triggers?
trophy, Morbus Sudeck). Currently, this disease pattern is
referred to as complex regional pain syndrome (CRPS). CRPS is a rare disease. Approximately 1% of patients de-
Two types are recognized: CRPS type I without nerve in- velop CRPS following a fracture or nerve injury. How-
jury and CRPS type II associated with major nerve injury. ever, exact data on prevalence do not exist. In a current
study from the Netherlands, the incidence was esti-
What are the main characteristics mated 26/100,000 persons per year, with females being
of patients with CRPS? aff ected at least three times more often than males. In
another population-based study from the United States,
As a general rule, the symptoms of CRPS manifest the incidence was estimated at 5.5/100,000 persons per
themselves in the distal extremity (usually in the upper year. Th e upper extremity is more often aff ected, and a
limb, and less often in the lower limb). Almost all pa- fracture is the most common trigger (60%).
tients (90–95%) suff er from pain, which is described as
burning and drilling and is felt deep in the tissue. Fur- What is the explanation for
thermore, an edema of the aff ected extremity, with an development of CRPS?
emphasis on the dorsal areas (dorsum of the hand or
foot) can be observed in almost all patients. Pain and In almost all of the patients (90–95%) there is an ini-
edema increase when the limb is hanging down. Further tiating noxious event (trauma) in the clinical history.
essential disease features are the following: (1) patients Th e reason why only some patients develop CRPS is
suff er from sensory, motor, and autonomic impairment; still unclear. Th ere is also no comprehensive theory
(2) the symptoms spread beyond the area of the primary that can explain the diversity and the heterogeneity
damage and cannot be assigned to the supply area of one of the symptoms (edema, central nervous symptoms,
Guide to Pain Management in Low-Resource Settings, edited by Andreas Kopf and Nilesh B. Patel. IASP, Seattle, © 2010. No responsibility is assumed by IASP 249
for any injury and/or damage to persons or property as a matter of product liability, negligence, or from any use of any methods, products, instruction, or
ideas contained in the material herein. Because of the rapid advances in the medical sciences, the publisher recommends that there should be independent
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