Complex Regional Pain Syndrome-Reflex Sympathetic Dystrophy

Complex regional pain syndrome-reflex sympathetic dystrophy (CRPS/RSD) is a complex pain-dysfunction syndrome of unknown cause that typically affects a single extremity. Changes are usually more marked peripherally. There are no generally accepted clinical diagnostic criteria or laboratory studies for CRPS/RSD; our current state of knowledge allows the diagnosis to be made only on clinical grounds. Clinical suspicion should be raised if pain and disability are greater than would usually be expected as a result of the original incident, if recovery is slower than expected, and if autonomic changes are prominent in the affected extremity. The pain associated with the condition may be sympathetically maintained, sympathetically independent, or both. No evidence-based treatment regimens for CRPS/RSD are available. Treatment of the individual patient is empiric and uses symptomatic techniques that seem logical or that have been proven to be effective in other conditions. The sympathetic nervous system makes an unknown contribution to CRPS/RSD, but it is not known whether this is a cause or an effect of the pain. Psychological and psychiatric changes are probably secondary rather than etiologic. Treatment should be immediate, aggressive, and directed toward restoration of full function of the extremity. Various analgesic techniques may be necessary to permit the patient to comply with the rehabilitation program. This program is best carried out in a comprehensive interdisciplinary setting, with a primary emphasis on functional restoration.