Complex Regional Pain Syndrome (CRPS) is a chronic neuropathic pain
disorder that involves one or more extremities with dystrophic
changes of the skin, muscle, or bone. CRPS is characterised by
constant regional neuropathic pain that does not follow the usual
dermatomal distribution or nerve territory. In addition to
neuropathic pain, patients suffer from sensory loss, autonomic
dysfunction, vasculature changes and motor dysfunction in the
region affected. As a debilitating disease with an unclear
pathophysiology, patients suffering from this disorder often do not
get the adequate level of care or treatment. Until recently, many
clinicians believed CRPS was a purely psychiatric ailment and was
lumped together with conditions such as conversion disorder. Recent
strides in the understanding of responses in both the nervous
system and body to trauma has allowed researchers and clinicians to
elucidate possible pathophysiology components for this disorder, as
well as to better understand the CRPS patient. Currently, CRPS is
viewed to be a multiple component disorder activated by the
dysfunction of multiple systems. This includes local injury
response, inflammatory response, central and peripheral nervous
sensitisation, abnormal vasculature changes and psychiatric
components. Herein, not only are the pathophysiological mechanisms
synthesised from current and past research discussed, but also the
available pharmaceutical, interventional, and rehabilitative
treatment modalities are reviewed in detail. From the
neurophysiology of physical therapy and psychiatric interventions,
to concepts in acupuncture, to evidence regarding peripheral and
central nerve blocks and implantable devices, and to mechanisms
involving supraspinal interventions used to directly manipulate
brain circuitry, CPRS treatment options are examined in detail.
Furthermore, as evidenced by the diverse and multimodal array of
available and emerging treatment modalities, it is clear that CRPS
management requires a truly interdisciplinary approach,
highlighting this book as a central reference for multiple
often-disconnected specialties. Furthermore, the mechanisms of
action in each intervention strategy, current evidence base, and
gaps in knowledge for management of CRPS are explored with special
emphasis on avenues for future research. CRPS is a pain syndrome
that has seen an explosion of research in recent decades, due in
part to the fairly recent development of internationally formalised
diagnostic criteria. However, many questions remain; while some
continue to build an evidence base for efficacy and safety of
current therapies, others are delving into new pharmaceutical
options, experimental therapies, and molecular-level strategies
focused on epigenetic manipulation. Moreover, this plethora of
emerging CRPS research will surely maintain this syndrome in the
forefront of medical research and scientific discovery for the next
several decades.
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