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The Natural History of Complex Regional Pain Syndrome

Schwartzman, Robert J. MD; Erwin, Kirsten L. BS; Alexander, Guillermo M. PhD

The Clinical Journal of Pain: May 2009 - Volume 25 - Issue 4 - p 273-280
doi: 10.1097/AJP.0b013e31818ecea5
Original Articles

Objective Complex regional pain syndrome (CRPS) is a severe chronic pain condition characterized by sensory, autonomic, motor, and dystrophic signs and symptoms. This study was undertaken to expand our current knowledge of the evolution of CRPS signs and symptoms with duration of disease.

Method This was a retrospective, cross-sectional analysis using data extracted from a patient questionnaire to evaluate the clinical characteristics of CRPS at different time points of disease progression. Data from the questionnaire included pain characteristics and associated symptoms. It also included autonomic, motor, and dystrophic symptoms and also initiating events, ameliorating and aggravating factors, quality of life, work status, comorbid conditions, pattern of pain spread, family history, and demographics. Comparisons were made of different parameters as they varied with disease duration.

Results A total of 656 patients with CRPS of at least 1-year duration were evaluated. The average age of all participants was 37.5 years, with disease duration varying from 1 to 46 years. The majority of participants were white (96%). A total of 80.3% were females. None of the patients in this study demonstrated spontaneous remission of their symptoms. The pain in these patients was refractory showing only modest improvement with most current therapies.

Discussion This study shows that although CRPS is a progressive disease, after 1 year, the majority of the signs and symptoms were well developed and although many variables worsen over the course of the illness, the majority demonstrated only moderate increases with disease duration.

Department of Neurology, Drexel University College of Medicine, Philadelphia, PA

Supported by a grant from the Tilly Family Foundation.

Reprints: Robert J. Schwartzman, MD, Department of Neurology, Drexel University College of Medicine, Mail Stop 423, 245 North 15th Street, Philadelphia, PA 19102 (e-mail:

Received for publication June 16, 2008; accepted September 21, 2008

© 2009 Lippincott Williams & Wilkins, Inc.