Advertisement

A 35-Year-Old Man with Persistent Pain After Hand Injury (Complex Regional Pain Syndrome)

  • Xiaoying Zhu
  • Lynn R. KohanEmail author
Chapter
  • 42 Downloads

Abstract

Complex regional pain syndrome is a pain condition that most often affects limbs, but can involve the rest of the human body. This condition may develop after trauma, surgery, or even minor injury. Its progression is phenotypically variable ranging from self-limiting mild to chronic debilitating disease, affecting patient’s quality of life and creating a burden for both the patient and the society. Early recognition and aggressive treatment may limit the disease progression. However, its underlying pathophysiology is complicated and poorly understood, making its diagnosis and treatment challenging. The diagnosis of complex regional pain syndrome relies on clinical findings as there is currently no specific diagnostic test to confirm it. A variety of therapies have been used to treat complex regional pain syndrome; however, most of the evidence for these treatments is of low quality. Further large-scale, well-designed clinical trials are needed to investigate the pathophysiological mechanisms and treatment modalities of the disorder.

Keywords

Complex regional pain syndrome Upper extremity pain Chronic pain Neuropathic pain Hand injury pain 

References

  1. 1.
    Harden RN, Bruehl S, Perez RS, Birklein F, Marinus J, Maihofner C, et al. Validation of proposed diagnostic criteria (the “Budapest criteria”) for complex regional pain syndrome. Pain. 2010;150(2):268–74.PubMedPubMedCentralGoogle Scholar
  2. 2.
    Birklein F, Schlereth T. Complex regional pain syndrome-significant progress in understanding. Pain. 2015;156(Suppl 1):S94–103.PubMedGoogle Scholar
  3. 3.
    Urits I, Shen AH, Jones MR, Viswanath O, Kaye AD. Complex regional pain syndrome, current concepts and treatment options. Curr Pain Headache Rep. 2018;22(2):10.  https://doi.org/10.1007/s11916-018-0667-7.CrossRefPubMedGoogle Scholar
  4. 4.
    Bruehl S, Maihofner C, Stanton-Hicks M, Perez RS, Vatine JJ, Brunner F, et al. Complex regional pain syndrome: evidence for warm and cold subtypes in a large prospective clinical sample. Pain. 2016;157(8):1674–81.PubMedGoogle Scholar
  5. 5.
    Marinus J, Moseley GL, Birklein F, Baron R, Maihofner C, Kingery WS, et al. Clinical features and pathophysiology of complex regional pain syndrome. Lancet Neurol. 2011;10(7):637–48.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Shi X, Wang L, Li X, Sahbaie P, Kingery WS, Clark JD. Neuropeptides contribute to peripheral nociceptive sensitization by regulating interleukin-1beta production in keratinocytes. Anesth Analg. 2011;113(1):175–83.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Parkitny L, McAuley JH, Di Pietro F, Stanton TR, O’Connell NE, Marinus J, et al. Inflammation in complex regional pain syndrome: a systematic review and meta-analysis. Neurology. 2013;80(1):106–17.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Meacham K, Shepherd A, Mohapatra DP, Haroutounian S. Neuropathic pain: central vs. peripheral mechanisms. Curr Pain Headache Rep. 2017;21(6):28.  https://doi.org/10.1007/s11916-017-0629-5.CrossRefPubMedGoogle Scholar
  9. 9.
    Eisenberg E, Chistyakov AV, Yudashkin M, Kaplan B, Hafner H, Feinsod M. Evidence for cortical hyperexcitability of the affected limb representation area in CRPS: a psychophysical and transcranial magnetic stimulation study. Pain. 2005;113(1–2):99–105.PubMedGoogle Scholar
  10. 10.
    Kohr D, Tschernatsch M, Schmitz K, Singh P, Kaps M, Schafer KH, et al. Autoantibodies in complex regional pain syndrome bind to a differentiation-dependent neuronal surface autoantigen. Pain. 2009;143(3):246–51.PubMedGoogle Scholar
  11. 11.
    Goebel A, Blaes F. Complex regional pain syndrome, prototype of a novel kind of autoimmune disease. Autoimmun Rev. 2013;12(6):682–6.PubMedGoogle Scholar
  12. 12.
    Albrecht PJ, Hines S, Eisenberg E, Pud D, Finlay DR, Connolly MK, et al. Pathologic alterations of cutaneous innervation and vasculature in affected limbs from patients with complex regional pain syndrome. Pain. 2006;120(3):244–66.PubMedGoogle Scholar
  13. 13.
    Oaklander AL, Rissmiller JG, Gelman LB, Zheng L, Chang Y, Gott R. Evidence of focal small-fiber axonal degeneration in complex regional pain syndrome-I (reflex sympathetic dystrophy). Pain. 2006;120(3):235–43.PubMedGoogle Scholar
  14. 14.
    Bruehl S. An update on the pathophysiology of complex regional pain syndrome. Anesthesiology. 2010;113(3):713–25.PubMedGoogle Scholar
  15. 15.
    Harden RN, Duc TA, Williams TR, Coley D, Cate JC, Gracely RH. Norepinephrine and epinephrine levels in affected versus unaffected limbs in sympathetically maintained pain. Clin J Pain. 1994;10(4):324–30.PubMedGoogle Scholar
  16. 16.
    Kurvers H, Daemen M, Slaaf D, Stassen F, van den Wildenberg F, Kitslaar P, et al. Partial peripheral neuropathy and denervation induced adrenoceptor supersensitivity. Functional studies in an experimental model. Acta Orthop Belg. 1998;64(1):64–70.PubMedGoogle Scholar
  17. 17.
    Schattschneider J, Hartung K, Stengel M, Ludwig J, Binder A, Wasner G, et al. Endothelial dysfunction in cold type complex regional pain syndrome. Neurology. 2006;67(4):673–5.PubMedGoogle Scholar
  18. 18.
    Dayan L, Salman S, Norman D, Vatine JJ, Calif E, Jacob G. Exaggerated vasoconstriction in complex regional pain syndrome-1 is associated with impaired resistance artery endothelial function and local vascular reflexes. J Rheumatol. 2008;35(7):1339–45.PubMedGoogle Scholar
  19. 19.
    Koban M, Leis S, Schultze-Mosgau S, Birklein F. Tissue hypoxia in complex regional pain syndrome. Pain. 2003;104(1–2):149–57.PubMedGoogle Scholar
  20. 20.
    Baron R, Schattschneider J, Binder A, Siebrecht D, Wasner G. Relation between sympathetic vasoconstrictor activity and pain and hyperalgesia in complex regional pain syndromes: a case-control study. Lancet. 2002;359(9318):1655–60.PubMedGoogle Scholar
  21. 21.
    Reinersmann A, Maier C, Schwenkreis P, Lenz M. Complex regional pain syndrome: more than a peripheral disease. Pain Manag. 2013;3(6):495–502.PubMedGoogle Scholar
  22. 22.
    Moseley GL. Distorted body image in complex regional pain syndrome. Neurology. 2005;65(5):773.PubMedGoogle Scholar
  23. 23.
    Lewis JS, Kersten P, McCabe CS, McPherson KM, Blake DR. Body perception disturbance: a contribution to pain in complex regional pain syndrome (CRPS). Pain. 2007;133(1–3):111–9.PubMedGoogle Scholar
  24. 24.
    Azqueta-Gavaldon M, Schulte-Gocking H, Storz C, Azad S, Reiners A, Borsook D, et al. Basal ganglia dysfunction in complex regional pain syndrome - a valid hypothesis? Eur J Pain. 2017;21(3):415–24.PubMedGoogle Scholar
  25. 25.
    Cappello ZJ, Kasdan ML, Louis DS. Meta-analysis of imaging techniques for the diagnosis of complex regional pain syndrome type I. J Hand Surg Am. 2012;37(2):288–96.PubMedGoogle Scholar
  26. 26.
    Maihofner C, Handwerker HO, Neundorfer B, Birklein F. Patterns of cortical reorganization in complex regional pain syndrome. Neurology. 2003;61(12):1707–15.PubMedGoogle Scholar
  27. 27.
    Pleger B, Tegenthoff M, Ragert P, Forster AF, Dinse HR, Schwenkreis P, et al. Sensorimotor retuning [corrected] in complex regional pain syndrome parallels pain reduction. Ann Neurol. 2005;57(3):425–9.PubMedGoogle Scholar
  28. 28.
    Sandroni P, Benrud-Larson LM, McClelland RL, Low PA. Complex regional pain syndrome type I: incidence and prevalence in Olmsted county, a population-based study. Pain. 2003;103(1–2):199–207.PubMedGoogle Scholar
  29. 29.
    de Mos M, Huygen FJ, van der Hoeven-Borgman M, Dieleman JP, Ch Stricker BH, Sturkenboom MC. Outcome of the complex regional pain syndrome. Clin J Pain. 2009;25(7):590–7.PubMedGoogle Scholar
  30. 30.
    van Rijn MA, Marinus J, Putter H, Bosselaar SR, Moseley GL, van Hilten JJ. Spreading of complex regional pain syndrome: not a random process. J Neural Transm (Vienna). 2011;118(9):1301–9.Google Scholar
  31. 31.
    Bean DJ, Johnson MH, Kydd RR. The outcome of complex regional pain syndrome type 1: a systematic review. J Pain. 2014;15(7):677–90.PubMedGoogle Scholar
  32. 32.
    de Mos M, de Bruijn AG, Huygen FJ, Dieleman JP, Stricker BH, Sturkenboom MC. The incidence of complex regional pain syndrome: a population-based study. Pain. 2007;129(1–2):12–20.PubMedGoogle Scholar
  33. 33.
    Elsharydah A, Loo NH, Minhajuddin A, Kandil ES. Complex regional pain syndrome type 1 predictors - epidemiological perspective from a national database analysis. J Clin Anesth. 2017;39:34–7.PubMedGoogle Scholar
  34. 34.
    Beerthuizen A, Stronks DL, Van’t Spijker A, Yaksh A, Hanraets BM, Klein J, et al. Demographic and medical parameters in the development of complex regional pain syndrome type 1 (CRPS1): prospective study on 596 patients with a fracture. Pain. 2012;153(6):1187–92.PubMedGoogle Scholar
  35. 35.
    Jellad A, Salah S, Ben Salah Frih Z. Complex regional pain syndrome type I: incidence and risk factors in patients with fracture of the distal radius. Arch Phys Med Rehabil. 2014;95(3):487–92.PubMedGoogle Scholar
  36. 36.
    Rewhorn MJ, Leung AH, Gillespie A, Moir JS, Miller R. Incidence of complex regional pain syndrome after foot and ankle surgery. J Foot Ankle Surg. 2014;53(3):256–8.PubMedGoogle Scholar
  37. 37.
    da Costa VV, de Oliveira SB, Fernandes Mdo C, Saraiva RA. Incidence of regional pain syndrome after carpal tunnel release. Is there a correlation with the anesthetic technique? Rev Bras Anestesiol. 2011;61(4):425–33.PubMedGoogle Scholar
  38. 38.
    Bruehl S, Harden RN, Galer BS, Saltz S, Bertram M, Backonja M, et al. External validation of IASP diagnostic criteria for complex regional pain syndrome and proposed research diagnostic criteria. International Association for the Study of Pain. Pain. 1999;81(1–2):147–54.PubMedGoogle Scholar
  39. 39.
    Chevreau M, Romand X, Gaudin P, Juvin R, Baillet A. Bisphosphonates for treatment of complex regional pain syndrome type 1: a systematic literature review and meta-analysis of randomized controlled trials versus placebo. Joint Bone Spine. 2017;84(4):393–9.PubMedGoogle Scholar
  40. 40.
    Harrison C, Epton S, Bojanic S, Green AL, FitzGerald JJ. The efficacy and safety of dorsal root ganglion stimulation as a treatment for neuropathic pain: a literature review. Neuromodulation. 2018;21(3):225–33.PubMedGoogle Scholar
  41. 41.
    Kapural L, Lokey K, Leong MS, Fiekowsky S, Stanton-Hicks M, Sapienza-Crawford AJ, et al. Intrathecal ziconotide for complex regional pain syndrome: seven case reports. Pain Pract. 2009;9(4):296–303.PubMedGoogle Scholar
  42. 42.
    Smart KM, Wand BM, O’Connell NE. Physiotherapy for pain and disability in adults with complex regional pain syndrome (CRPS) types I and II. Cochrane Database Syst Rev. 2016;2:CD010853.PubMedGoogle Scholar
  43. 43.
    Zyluk A, Puchalski P. Effectiveness of complex regional pain syndrome treatment: a systematic review. Neurol Neurochir Pol. 2018;52:326.PubMedGoogle Scholar
  44. 44.
    Duong S, Bravo D, Todd KJ, Finlayson RJ, Tran Q. Treatment of complex regional pain syndrome: an updated systematic review and narrative synthesis. Can J Anaesth. 2018;65:658.PubMedGoogle Scholar
  45. 45.
    Harden RN, Oaklander AL, Burton AW, Perez RS, Richardson K, Swan M, et al. Complex regional pain syndrome: practical diagnostic and treatment guidelines, 4th edition. Pain Med. 2013;14(2):180–229.PubMedGoogle Scholar
  46. 46.
    Goh EL, Chidambaram S, Ma D. Complex regional pain syndrome: a recent update. Burns Trauma. 2017;5:2.  https://doi.org/10.1186/s41038-016-0066-4. eCollection 2017.CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Evaniew N, McCarthy C, Kleinlugtenbelt YV, Ghert M, Bhandari M. Vitamin C to prevent complex regional pain syndrome in patients with distal radius fractures: a meta-analysis of randomized controlled trials. J Orthop Trauma. 2015;29(8):e235–41.PubMedGoogle Scholar
  48. 48.
    Straube S, Derry S, Moore RA, Cole P. Cervico-thoracic or lumbar sympathectomy for neuropathic pain and complex regional pain syndrome. Cochrane Database Syst Rev. 2013;(9):CD002918.Google Scholar
  49. 49.
    Goebel A, Bisla J, Carganillo R, Frank B, Gupta R, Kelly J, et al. Low-dose intravenous immunoglobulin treatment for long-standing complex regional pain syndrome: a randomized trial. Ann Intern Med. 2017;167(7):476–83.PubMedGoogle Scholar
  50. 50.
    Connolly SB, Prager JP, Harden RN. A systematic review of ketamine for complex regional pain syndrome. Pain Med. 2015;16(5):943–69.PubMedGoogle Scholar
  51. 51.
    Visnjevac O, Costandi S, Patel BA, Azer G, Agarwal P, Bolash R, et al. A comprehensive outcome-specific review of the use of spinal cord stimulation for complex regional pain syndrome. Pain Pract. 2017;17(4):533–45.PubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of AnesthesiologyUniversity of Virginia Health SystemCharlottesvilleUSA

Personalised recommendations