Published online Mar 27, 2014. doi: 10.5313/wja.v3.i1.46
Revised: November 16, 2013
Accepted: December 13, 2013
Published online: March 27, 2014
Complex regional pain syndrome (CRPS) is a debilitating pathology characterised by intense chronic pain associated with vasomotor, sensory and motor dysfunction of the affected limb. Although the pathophysiology of CRPS is not fully understood, it is recognised that inflammatory processes and autonomic dysfunction are involved. These processes are associated with peripheral and central sensitisation as well as changes in brain structure and function, and are reflected in the clinical presentation of CRPS. CRPS management requires an interdisciplinary team and requires the therapeutic approach to be individualised. With regard to pharmacological treatment, bisphosphonates, corticosteroids, ketamine and anticonvulsants have been demonstrated to be effective for CRPS management. Psychotherapy, including cognitive-behavioural therapy, has produced promising results but more studies are needed to confirm its efficacy. Among rehabilitation interventions, there is evidence of the efficacy of physiotherapy and occupational therapy in diminishing CRPS symptoms and achieving a higher level of functioning. In this regard, the rehabilitation modality that seems the most promising according to the actual literature is graded motor imagery, which can help to reverse the maladaptive neuroplasticity occurring in CRPS.
Core tip: Complex regional pain syndrome (CRPS) involves a complex pathophysiology including sensory, motor and autonomic disturbances that causes functional disability and reduced quality of life. The management of CRPS remains challenging for health care professionals. This review provides a summary of the recent literature on CRPS pathophysiology and management. The potential mechanisms of effective interventions are also discussed.