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COMPLEX REGIONAL PAIN SYNDROME: EVOLVING UNDERSTANDING OF PATHOGENESIS AND IMPLICATIONS FOR TREAMENT

Naleschinski, Dennis; Baron, Ralf

CONTINUUM: Lifelong Learning in Neurology: October 2009 - Volume 15 - Issue 5, Neuropathic Pain - p 47-69
doi: 10.1212/01.CON.0000348854.58383.e5
Article

Complex regional pain syndrome (CRPS) is clinically characterized by pain, abnormal regulation of blood flow and sweating, edema of skin and subcutaneous tissues, active and passive movement disorders, and trophic changes. It is classified as type I (reflex sympathetic dystrophy) and type II (causalgia). CRPS cannot be reduced to one system or to one mechanism only. Changes in somatosensory systems processing afferent information in sympathetic systems and in the somatomotor system indicate that the central representations are altered. Edema, inflammation, and sympathetic-afferent interaction (sympathetically maintained pain) point to peripheral abnormalities. Treatment of the individual patient is empiric, mainly using evidence-based techniques that have been proven to be effective in other neuropathic conditions. Treatment should be immediate and most importantly directed toward restoration of full function of the extremity. This objective is best attained in a comprehensive interdisciplinary setting with particular emphasis on pain management and functional restoration.

Relationship Disclosure: Dr Naleschinski has received honoraria for speaking from Genzyme Corporation, H. Grünenthal, and Pfizer Inc. Dr Baron has received personal compensation for consulting from Allergan, Inc., Eisai Inc., Genzyme Corporation, H. Grünenthal, Medtronic, Inc., Mundipharma, Pfizer Inc, Sanofi Pasteur, and Schwarz Pharma. Dr Baron has received grant/research support from Genzyme Corporation, H. Grünenthal, and Pfizer Inc.

Unlabeled Use of Products/Investigational Use Disclosure: Drs Naleschinski and Baron discuss treatment approaches that have not been specifically investigated in large controlled, randomized, clinical trials for complex regional pain syndrome.

© 2009 American Academy of Neurology
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