Complex regional pain syndrome and amputation

Complex regional pain syndrome (CRPS) is a debilitating poorly understood condition with unpredictable course and heterogeneous therapeutic responses. Early, coordinated multidisciplinary management, including psychological and psychiatric support, is essential. In severe, therapy-resistant CRPS (long-standing CRPS), particularly intractable infection or severe recurrent wounds, amputation may be considered as a last-resort intervention after thorough multidisciplinary assessment and failure of conservative or less invasive strategies. Amputation rarely results in pain resolution, as CRPS may recur in the stump or another limb, and phantom limb pain may be developed. Additionally, recurrence of ulceration or inability to use a prosthesis may be present. Combination of amputation with prophylactic nerve management techniques (e.g., TMR) or adjuvant treatments, such as ketamine infusion or dorsal root ganglion stimulation, may lead to better outcomes after surgery. The identification of new potential indicators for prognosis might help guide decision-making regarding amputation. Further research is now required.