Complex Regional Pain Syndrome Management
Summary
Complex Regional Pain Syndrome (CRPS) is a multifactorial pain disorder that typically arises after limb trauma or surgery and is characterised by disproportionate pain, sensory disturbances, autonomic dysfunction and trophic changes. The condition often evolves through an initial “warm” phase dominated by local inflammation, vasodilatation and oedema, into a “cold” chronic phase in which central and peripheral sensitisation, altered sympathetic regulation and structural changes in skin, muscle and bone predominate. Diagnosis remains clinical, relying on standardised criteria to exclude alternative causes, and management demands a multidisciplinary approach. Pharmacological agents—ranging from anti-inflammatory steroids, bisphosphonates and free-radical scavengers to neuropathic pain modulators and ketamine infusions—are tailored to the dominant pathophysiological process. Physical and occupational therapies, incorporating graded motor imagery, mirror therapy and structured exercise programmes, aim to restore function and counteract disuse. Psychological support addresses pain-related fear, functional limitation and mood disorders. Emerging interventions include targeted neurostimulation of peripheral nerves or the dorsal root ganglion and immunomodulatory strategies guided by detailed phenotyping. Personalised care pathways and early intervention are crucial to improve outcomes and reduce progression to chronic, refractory pain.
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Complex Regional Pain Syndrome Management publication trend
The graph below shows the total number of articles in complex regional pain syndrome management across all publications each year (not limited to Nature Index journals).
Technical terms
Allodynia: Pain elicited by a stimulus that does not normally provoke pain.
Hyperalgesia: Exaggerated pain response to a stimulus that is normally painful.
Nociceptive sensitisation: Increased responsiveness of peripheral or central pain pathways following injury or inflammation.
NMDA receptor: A glutamate-gated ion channel involved in synaptic plasticity and central sensitisation.
Peripheral blood mononuclear cell (PBMC): A group of blood cells with a single round nucleus, including lymphocytes and monocytes, used to assess systemic immune activation.
Cytokine: A small protein secreted by immune cells that mediates and regulates inflammation and immune responses.
References
- Transient immune activation without loss of intraepidermal innervation and associated Schwann cells in patients with complex regional pain syndrome. Journal of Neuroinflammation (2024).
- Inflammation induces α1-adrenoceptor expression in peripheral blood mononuclear cells of patients with complex regional pain syndrome. Brain Behavior and Immunity (2023).
- NMDA Receptors Regulate Oxidative Damage in Keratinocytes during Complex Regional Pain Syndrome in HaCaT Cells and Male Rats. Antioxidants (2024).
- Acute versus chronic phase mechanisms in a rat model of CRPS. Journal of Neuroinflammation (2016).
About these summaries
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