La sindrome algodistrofica o Complex Regional Pain Syndrome type 1

Abstract

Complex regional pain syndrome (CRPS) includes a wide range of conditions affecting a peripheral limb characterised by chronic disabling pain that is seemingly disproportionate in time or degree to the usual course of any known trauma or other lesion. Pain is regional and it is typically associated with abnormal sensory, motor, sudomotor, vasomotor and/or trophic findings. The pathophysiology is still poorly understood. The disease shows a female preponderance with a peak age of incidence around the 5th and 6th decade. The available diagnostic criteria for CRPS-I rely exclusively on clinical criteria, that are unfortunately focused on the signs and symptoms of the chronic and late disease, while little emphasis is given to the typical imaging (X-rays, bone scintigraphy, MRI) findings of the early phase. Over the last decades, several therapies have been proposed but the few studies available are often too small to be conclusive and rarely evolved to randomised controlled trials (RCTs). On the basis of the results of a few RCTs, only bisphosphonate therapy appears to provide substantial benefits, especially in patients in the early phase of the disease, often leading to persistent remission or complete healing. In conclusion, short courses of high doses of bisphosphonates should be considered the treatment of choice for patients with CRPS-I.