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Complex regional pain syndrome (CRPS) is an uncommon consequence of trauma or illness affecting a limb. This fascinating and controversial disorder is noteworthy for the wide variety of preceding/inciting events. In some cases, the disorder follows minor trauma, such as a bee sting or routine venipuncture. In others, major trauma has taken place, such as complex fractures with nerve injury or a bullet wound. Symptoms and signs emerge over hours to weeks in the affected limb and are distinctly different from normal posttraumatic healing. CRPS can be diagnosed if the following criteria are fulfilled:1 1) The patient has continuing pain, which is disproportionate to any inciting event. 2) The patient reports one symptom in three and shows one sign in two of the following four categories: a) hyperalgesia, hyperesthesia; b) skin temperature asymmetry, skin color change, or asymmetry; c) sweating asymmetry, edema; d) decreased range of motion, dystonia, tremor, weakness, trophic changes of hairs or nails. 3) There is no alternative diagnosis to explain the signs and symptoms.
The pathophysiology of CRPS remains incompletely defined. There has long been a suspicion that the disorder is an inflammatory response gone awry.2 In the beginning, there might be a trauma-related release of cytokines,3 which sensitize primary afferent nerve fibers. If these sensitized fibers become active, spontaneously or when mechanically stimulated by movement, an exaggerated release of neuropeptides would occur. Support …
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