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Complex Regional Pain Syndrome
Derik L. Davis, MD; B. J. Manaster, MD, PhD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Clinical Issues

        • Diagnostic Checklist

          TERMINOLOGY

          • Abbreviations

            • Complex regional pain syndrome (CRPS)
          • Synonyms

            • Reflex sympathetic dystrophy (RSD); causalgia, Sudeck atrophy; algodystrophy, shoulder-hand syndrome
          • Definitions

            • Chronic disorder presenting with pain to nonpainful stimuli (allodynia)
            • Etiology is not well understood
            • Subtypes
              • CRPS type 1: no detectable nerve lesion
              • CRPS type 2: detectable nerve lesion with resultant pain along distribution of nerve
            • Clinical diagnosis is based on Budapest criteria

          IMAGING

          • General Features

            • Imaging Recommendations

              • Radiographic Findings

                • CT Findings

                  • MR Findings

                    • Nuclear Medicine Findings

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Staging, Grading, & Classification

                            • Gross Pathologic & Surgical Features

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          Selected References

                                          1. Taylor SS et al: Complex regional pain syndrome: a comprehensive review. Pain Ther. 10(2):875-92, 2021
                                          2. Agten CA et al: MRI of complex regional pain syndrome in the foot. Eur J Radiol. 129:109044, 2020
                                          3. Howard BA et al: Utility of radionuclide bone scintigraphy in complex regional pain syndrome. Curr Pain Headache Rep. 22(1):7, 2018
                                          4. Birklein F et al: Complex regional pain syndrome-significant progress in understanding. Pain. 156 Suppl 1:S94-103, 2015
                                          5. Dirckx M et al: The prevalence of autoantibodies in complex regional pain syndrome type I. Mediators Inflamm. 2015:718201, 2015
                                          6. Lee DH et al: Brain alterations and neurocognitive dysfunction in patients with complex regional pain syndrome. J Pain. 16(6):580-6, 2015
                                          7. Bove GM: Focal nerve inflammation induces neuronal signs consistent with symptoms of early complex regional pain syndromes. Exp Neurol. 219(1):223-7, 2009
                                          8. Nishida Y et al: Skeletal muscle MRI in complex regional pain syndrome. Intern Med. 48(4):209-12, 2009
                                          9. Oaklander AL et al: Is reflex sympathetic dystrophy/complex regional pain syndrome type I a small-fiber neuropathy? Ann Neurol. 65(6):629-38, 2009
                                          10. Schwartzman RJ et al: The natural history of complex regional pain syndrome. Clin J Pain. 25(4):273-80, 2009
                                          11. Schwenkreis P et al: Functional imaging of central nervous system involvement in complex regional pain syndrome. AJNR Am J Neuroradiol. 30(7):1279-84, 2009
                                          12. Swart CM et al: Cortical changes in complex regional pain syndrome (CRPS). Eur J Pain. 13(9):902-7, 2009
                                          13. Tan EC et al: Quality of life in adults with childhood-onset of complex regional pain syndrome type I. Injury. 40(8):901-4, 2009
                                          14. Geha PY et al: The brain in chronic CRPS pain: abnormal gray-white matter interactions in emotional and autonomic regions. Neuron. 60(4):570-81, 2008
                                          15. Lebel A et al: fMRI reveals distinct CNS processing during symptomatic and recovered complex regional pain syndrome in children. Brain. 131(Pt 7):1854-79, 2008
                                          16. Park SG et al: Quantitative evaluation of very acute stage of complex regional pain syndrome after stroke using three-phase bone scintigraphy. Nucl Med Commun. 28(10):766-70, 2007
                                          17. Schürmann M et al: Imaging in early posttraumatic complex regional pain syndrome: a comparison of diagnostic methods. Clin J Pain. 23(5):449-57, 2007
                                          18. Pankaj A et al: Diagnosis of post-traumatic complex regional pain syndrome of the hand: current role of sympathetic skin response and three-phase bone scintigraphy. J Orthop Surg (Hong Kong). 14(3):284-90, 2006
                                          19. Intenzo CM et al: The role of nuclear medicine in the evaluation of complex regional pain syndrome type I. Clin Nucl Med. 30(6):400-7, 2005
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Clinical Issues

                                                • Diagnostic Checklist

                                                  TERMINOLOGY

                                                  • Abbreviations

                                                    • Complex regional pain syndrome (CRPS)
                                                  • Synonyms

                                                    • Reflex sympathetic dystrophy (RSD); causalgia, Sudeck atrophy; algodystrophy, shoulder-hand syndrome
                                                  • Definitions

                                                    • Chronic disorder presenting with pain to nonpainful stimuli (allodynia)
                                                    • Etiology is not well understood
                                                    • Subtypes
                                                      • CRPS type 1: no detectable nerve lesion
                                                      • CRPS type 2: detectable nerve lesion with resultant pain along distribution of nerve
                                                    • Clinical diagnosis is based on Budapest criteria

                                                  IMAGING

                                                  • General Features

                                                    • Imaging Recommendations

                                                      • Radiographic Findings

                                                        • CT Findings

                                                          • MR Findings

                                                            • Nuclear Medicine Findings

                                                              DIFFERENTIAL DIAGNOSIS

                                                                PATHOLOGY

                                                                • General Features

                                                                  • Staging, Grading, & Classification

                                                                    • Gross Pathologic & Surgical Features

                                                                      • Microscopic Features

                                                                        CLINICAL ISSUES

                                                                        • Presentation

                                                                          • Demographics

                                                                            • Natural History & Prognosis

                                                                              • Treatment

                                                                                DIAGNOSTIC CHECKLIST

                                                                                • Consider

                                                                                  Selected References

                                                                                  1. Taylor SS et al: Complex regional pain syndrome: a comprehensive review. Pain Ther. 10(2):875-92, 2021
                                                                                  2. Agten CA et al: MRI of complex regional pain syndrome in the foot. Eur J Radiol. 129:109044, 2020
                                                                                  3. Howard BA et al: Utility of radionuclide bone scintigraphy in complex regional pain syndrome. Curr Pain Headache Rep. 22(1):7, 2018
                                                                                  4. Birklein F et al: Complex regional pain syndrome-significant progress in understanding. Pain. 156 Suppl 1:S94-103, 2015
                                                                                  5. Dirckx M et al: The prevalence of autoantibodies in complex regional pain syndrome type I. Mediators Inflamm. 2015:718201, 2015
                                                                                  6. Lee DH et al: Brain alterations and neurocognitive dysfunction in patients with complex regional pain syndrome. J Pain. 16(6):580-6, 2015
                                                                                  7. Bove GM: Focal nerve inflammation induces neuronal signs consistent with symptoms of early complex regional pain syndromes. Exp Neurol. 219(1):223-7, 2009
                                                                                  8. Nishida Y et al: Skeletal muscle MRI in complex regional pain syndrome. Intern Med. 48(4):209-12, 2009
                                                                                  9. Oaklander AL et al: Is reflex sympathetic dystrophy/complex regional pain syndrome type I a small-fiber neuropathy? Ann Neurol. 65(6):629-38, 2009
                                                                                  10. Schwartzman RJ et al: The natural history of complex regional pain syndrome. Clin J Pain. 25(4):273-80, 2009
                                                                                  11. Schwenkreis P et al: Functional imaging of central nervous system involvement in complex regional pain syndrome. AJNR Am J Neuroradiol. 30(7):1279-84, 2009
                                                                                  12. Swart CM et al: Cortical changes in complex regional pain syndrome (CRPS). Eur J Pain. 13(9):902-7, 2009
                                                                                  13. Tan EC et al: Quality of life in adults with childhood-onset of complex regional pain syndrome type I. Injury. 40(8):901-4, 2009
                                                                                  14. Geha PY et al: The brain in chronic CRPS pain: abnormal gray-white matter interactions in emotional and autonomic regions. Neuron. 60(4):570-81, 2008
                                                                                  15. Lebel A et al: fMRI reveals distinct CNS processing during symptomatic and recovered complex regional pain syndrome in children. Brain. 131(Pt 7):1854-79, 2008
                                                                                  16. Park SG et al: Quantitative evaluation of very acute stage of complex regional pain syndrome after stroke using three-phase bone scintigraphy. Nucl Med Commun. 28(10):766-70, 2007
                                                                                  17. Schürmann M et al: Imaging in early posttraumatic complex regional pain syndrome: a comparison of diagnostic methods. Clin J Pain. 23(5):449-57, 2007
                                                                                  18. Pankaj A et al: Diagnosis of post-traumatic complex regional pain syndrome of the hand: current role of sympathetic skin response and three-phase bone scintigraphy. J Orthop Surg (Hong Kong). 14(3):284-90, 2006
                                                                                  19. Intenzo CM et al: The role of nuclear medicine in the evaluation of complex regional pain syndrome type I. Clin Nucl Med. 30(6):400-7, 2005