What Is Complex Regional Pain Syndrome (CRPS):

What Is Reflex Sympathetic Dystrophy/Complex Regional Pain Syndrome 1&2 (RSD/CRPS 1&2)?: rheumatology.oxfordjournals.org/cgi/content/full/39/7/692

Reflex sympathetic dystrophy (RSD) is a condition characterized by localized or diffuse pain, usually with associated swelling, trophic changes and vasomotor disturbance [1].

Allodynia, hyperhydrosis, and nail or hair growth changes may also occur.

Motor abnormalities have been reported [2], in particular, tremor, involuntary movement and muscle spasm.

Contractures may occur in the later stages.

Involvement may be either unilateral or bilateral. Most commonly recognized is peripheral disease [3], although RSD may affect any region of the trunk or limbs.

There is often a history of trauma, occasionally of such low significance that it may be overlooked by the patient.

Symptoms may occur up to 6 months after injury [4]. Other triggering factors have been reported.

Several drugs have been implicated, for example, phenobarbitone, phenytoin, isoniazid [5], and the immunosuppressive agents cyclosporin [6] and tacrolimus [7], as has surgery or a neurological event, particularly with peripheral manifestations.

Rapamycin is currently under investigation as an immunosuppressive agent administered after solid organ transplantation.

A recent report associated this drug with bone pain, osteolysis on plain radiographs and high uptake of tracer on isotope bone scanning.

Resolution of symptoms occurred on withdrawal or reduction of rapamycin, or following administration of the bisphosphonate pamidronate [8].

Concurrent medical conditions may predispose to RSD, and diabetes mellitus, hyperthyroidism, hyperparathyroidism and type IV hyperlipidaemia have all been associated.

RSD may occur at any age, and is well recognized in children, where vasomotor changes may be particularly marked [9–11].

Chronic pain in a poorly understood condition may cause depression and isolation, and although a higher rate of psychological abnormalities has been reported, this appears to be little different from other patient groups who suffer chronic pain [12, 13].

What Is Reflex Sympathetic Dystrophy/Complex Regional Pain Syndrome 1&2 (RSD/CRPS 1&2)?: www.rsdfoundation.org/en/pdfs/fulltext.pdf

COMPLEX regional pain syndrome (CRPS) type I, formerly
known as reflex sympathetic dystrophy (RSD),
and CRPS type II, formerly known as causalgia, are
debilitating pain syndromes that have been recognized
for more than a century.

Despite the long history of these disorders, the natural course and pathophysiology of CRPS types I and II are elusive, and hence, their therapies remain controversial.

The following overview highlights the clinically relevant aspects of CRPS type I in adults to guide practitioners in treating these patients.

The reader is referred to recent reviews for discussions about the proposed pathophysiologic mechanisms of this syndrome.

What Is Reflex Sympathetic Dystrophy/Complex Regional Pain Syndrome 1&2 (RSD/CRPS 1&2)?: ep.eur.nl/retrieve/2515/02.pdf & ep.eur.nl/bitstream/1765/1155/18/Schasfoort+Dissertation.pdf

Introduction: ep.eur.nl/retrieve/2515/02.pdf & ep.eur.nl/bitstream/1765/1155/18/Schasfoort+Dissertation.pdf

Complex Regional Pain Syndrome Type I (CRPSI; also known as Reflex Sympathetic Dystrophy) is a poorly understood and not well defined symptom complex comprising a combination of sensory, trophic, autonomic and motor impairments 1, 2.

The syndrome usually follows surgery or trauma, and is generally expressed in the
extremities.

In addition to the impairments, CRPSI can lead to serious disabilities performing activities of daily life and handicap 3, 4.

In the acute phase of CRPSI, pain in particular may constitute a major cause of disability and/or handicap, whereas during the later stages CRPSI associated motor impairments, together with pain, are
thought to bring about disabilities and/or handicaps 1, 5, 6.

The complex entity of CRPSI has often been investigated, leading, however, to confusing and conflicting results and theories about the aetiology and pathophysiology 7.

As the disease is not yet understood, plus the fact that each speciality has its own discipline-specific
approach, a wide variety of treatments (more than 50) are found in literature 8.

As a consequence, numerous measures to determine treatment outcome have been described.

In the present paper, the numerous measures that are used to determine treatment outcome in CRPSI research and clinical practice will be classified.

So far, one of the difficulties in interpreting reports on treatment efficacy in CRPSI, has been the
(objective) quantification of patient findings and the lack of uniform measurement of treatment outcome 9, 10.

Classification of outcome measures may not only be a useful tool to indicate the extent of the (obvious) inconsistency in defining treatment outcome in CRPSI research.

The main aim of classifying outcome measures in the
present paper is to determine whether relevant and objective outcome measures for rehabilitation medicine are available.

It is clear that objective outcome measures are
preferable to subjective outcome measures; the latter are more likely to endanger reliability and validity of measurements.

As for the relevance of outcome measures:

outcome measures are considered most relevant for rehabilitation medicine when they concern the goal of rehabilitation, that is regaining and/or maintaining of functionality by decreasing the consequences of a disease 11, 12.

Outcome measures concerning impairments are considered less relevant for rehabilitation medicine,
especially since the relation between the consequences of a disease is often found to be rather ambiguous 13-15.


The international classification of impairments, disabilities and handicaps (ICIDH) 16 is an often-used classification, in which three hierarchical levels of the consequences of a disease on everyday life of patients are distinguished.

Outcome measures on the level of impairments, disabilities and handicaps concern the consequences of diseases at the level of the body, the person and the person as a social being, respectively.

As for CRPSI, the consequences at the ICIDH level of impairments can be categorised into sensory impairments (e.g. neuropathic pain, allodynia, hyperalgesia, hypesthesia, anaesthesia, dysesthesia, hyperpathia), autonomic impairments (e.g. oedema, hyperhydrosis, skin colour change, change of temperature), trophic impairments (e.g. atrophy of skin, nails, muscles and bone), and motor impairments (e.g. dystonia, weakness, spasms, tremor, difficulty initiating movement, increased tone and reflexes, and increase of complaints after exercise) 8.

Disabilities associated with CRPSI are those directly related to the involved extremity (e.g. problems with getting dressed with upper extremity CRPSI or climbing stairs with lower extremity CRPSI) and general disabilities in daily functioning (e.g. slow
performance of activities of daily living).

Handicaps associated with CRPSI concern
limitations in social functioning (e.g. alienation) and problems with role fulfilment (e.g. a grandmother with CRPSI cannot play with her grandchild), as a consequence of pain, other impairments or disabilities 17.

From this list of consequences it becomes clear that CRPSI encompasses all three levels of the consequences of a disease as described in the ICIDH.

Although some discussion continues about the sometimes
unclear distinction between the theoretical levels of the ICIDH 18, 19, we consider the ICIDH framework useful to classify outcome measures in order to make a statement on availability of relevant and objective outcome measures for rehabilitation
medicine.<br><br>Post edited by: Scott_1984, at: 2007/10/25 00:38

What Is Reflex Sympathetic Dystrophy/Complex Regional Pain Syndrome 1&amp;2 (RSD/CRPS 1&amp;2)?: www.ninds.nih.gov/news_and_events/procee...c_Dystrophy_2001.htm

Background: www.ninds.nih.gov/news_and_events/procee...c_Dystrophy_2001.htm

Reflex Sympathetic Dystrophy (RSD), also known as Complex Regional Pain Syndrome (CRPS) Type I (here called RSD/CRPS), is a chronic condition characterized by burning pain and abnormalities in the sensory, motor and autonomic nervous systems.

The syndrome typically appears after an acute injury to a joint or limb, though it may occur with no obvious precipitating event.

In most cases, regardless of the site of injury the symptoms begin and remain most intense in the distal most extremity.

In the initial stages of RSD/CRPS, pain and swelling from the injury do not subside but actually intensify, spreading from the site of the injury to other parts of the limb, to the contralateral limb or to remote regions of the body.

The skin in affected areas and particularly deep somatic tissues are painfully sensitive to touch, often red and abnormally warm due to alterations in regional blood flow.

Changes in sweating patterns, hair growth, subcutaneous tissues, muscles, joints or bones and difficulty moving the joint or limb are other hallmarks of the disorder.

In addition to the evidence of inflammation and abnormal autonomic nervous system function, there are changes in motor systems including tremor, weakness and dystonia, which strongly suggest a central nervous system component to the disease in a subgroup of patients.

The syndrome may evolve through three stages (acute, dystrophic, atrophic), although this is very much debated, each marked by progressive pain and physical changes in the skin, muscles, joints and bones.

RSD/CRPS can affect both genders and all ages (including children), although it is thought to be more common between the ages of 40 and 60 and may be more frequent in women.

The cause of RSD/CRPS is unknown, and current treatments are not effective for many patients.

What Is Reflex Sympathetic Dystrophy/Complex Regional Pain Syndrome 1&amp;2 (RSD/CRPS 1&amp;2)?: www.eorthopod.com/public/patient_educati...l_pain_syndrome.html

Complex regional pain syndrome (CRPS) is a condition of chronic pain and sensory changes that can occur after trauma to an arm or a leg.

The initial injury may be minor or severe.

Pain is the main feature of CRPS, but changes in blood flow to the skin, increased sweating, and swelling are common symptoms.

Movement disorders (MDs) such as tremor or dystonia develop in up to half the patients with CRPS. Dystonia is an abnormal twisting posture of the hand or foot.

In this study from the Netherlands, patients with CRPS and dystonia are compared to patients with CRPS who do not have MDs.

The authors tried to find out what causes the MDs to develop.

They looked at age, duration of symptoms, type of injury, and severity of symptoms as possible factors that cause MDs to develop.

They were able to come to several conclusions after comparing the two groups.

First, the patients who developed dystonia were younger than patients in the group without dystonia.

The length of time between the start of CRPS and the start of dystonia varies greatly.

For some patients this interval of time was within one week.

For others, the MD started up to five years later.

They found that once one extremity was affected, the chances of a second (or more) limb(s) developing dystonia increased greatly.

It's still not clear what causes dystonia to develop.

It's not linked to age, age, gender, or type of trauma.

Disease duration or which limb is affected first doesn't seem to make a difference either.

It looks like a central processing problem in the nervous system.

There may be many neural circuits at multiple levels affected causing the problem.

A change in function of nerve fibers capable of starting an inflammatory response may be the basis of the problem.

The authors refer to this as a central circuit disorder.

There is a poor prognosis for CRPS patients who have dystonia.

Finding out the underlying cause of the problem may help scientists find a way to prevent this from happening.

What Is Reflex Sympathetic Dystrophy/Complex Regional Pain Syndrome 1&amp;2 (RSD/CRPS 1&amp;2)?: www.nlm.nih.gov/medlineplus/complexregionalpainsyndrome.html

Complex Regional Pain Syndrome: www.nlm.nih.gov/medlineplus/complexregionalpainsyndrome.html

Also called: Causalgia, CRPS, Reflex sympathetic dystrophy: www.nlm.nih.gov/medlineplus/complexregionalpainsyndrome.html

Complex regional pain syndrome (CRPS) is an uncommon nerve disorder.

It causes intense pain, usually in the arms, hands, legs or feet.

It happens after an injury, either to a nerve or to tissue in the affected area.

Rest and time may only make it worse.

Doctors are not sure what causes it.

Symptoms in the affected area are:

*Dramatic changes in temperature and color

*Intense burning pain

*Extreme skin sensitivity

The cause of CRPS is unknown, and there is no cure.

It can get worse over time, and may spread to other parts of the body.

Occasionally it goes away, either temporarily or for good.

Treatment focuses on relieving the pain, and can include medicines, physical therapy and nerve blocks.