Search Results (70)

A 15-year-old female developed refractory Complex Regional Pain Syndrome (CRPS) Type I of the left hand following metacarpal fixation. Conservative therapy and hand rehabilitation failed, resulting in persistent allodynia and functional loss. She was admitted for multimodal analgesia combining subanesthetic ketamine infusion, gabapentin, and a tunneled supraclavicular continuous nerve catheter delivering ropivacaine. Pain decreased from 7/10 at rest to 0/10 within 48 h. Allodynia has resolved, and motor function has fully recovered. The catheter was removed nine days later without complication, and pain remission persisted. This case demonstrates a safe and effective multimodal strategy for adolescent CRPS integrating central and peripheral desensitization mechanisms. Full article

Background/Objectives: Stellate ganglion block (SGB) is an interventional technique frequently applied to manage pain associated with sympathetic dysfunction. This study aimed to evaluate the short-term clinical outcomes and tolerability of SGB in patients with different pain phenotypes. Methods: From 1 January 2024 through 1 March 2025, 96 patients who underwent fluoroscopy-guided SGB at a single center were retrospectively analyzed. The Oswestry Disability Index (ODI) was used to assess functional status, the SF-36 was applied to evaluate health-related quality of life, and the Visual Analog Scale (VAS) was employed to measure pain intensity. This study included baseline measurements and follow-up evaluations at 1, 3, and 6 months after the procedure. Results: Statistically significant improvements were observed in VAS, ODI, and SF-36 scores across all pain groups (p < 0.001). The largest median VAS reductions were observed in the migraine (4.0 [3.5–5.0]) and complex regional pain syndrome (CRPS) (3.7 [3.0–4.5]) groups, both exceeding the minimal clinically important difference (MCID). Patients with neuropathic and nociceptive pain showed smaller median reductions (3.4 [2.8–4.0] and 3.0 [2.5–3.8], respectively). The highest proportion of responders (≥50% VAS reduction) was noted in the migraine group (64.3%), while the lowest occurred in the nociceptive group (37.5%). Multivariate analysis identified pain phenotype as the only independent predictor of favorable outcomes, particularly in migraine and CRPS. Minor transient complications occurred in 9.4% of patients, all resolving spontaneously. Conclusions: SGB was well tolerated and associated with significant pain reduction and functional improvement. The observed clinical benefits may reflect mechanisms involving both peripheral and central sympathetic modulation. Larger multicenter prospective studies with extended follow-up are warranted to confirm these findings. Full article

Background: Complex Regional Pain Syndrome (CRPS) is a chronic pain condition that usually affects a limb following injury or surgery and is characterized by severe pain accompanied by sensory, motor, autonomic, and trophic disturbances. Methods: This systematic review aimed to synthesize the available evidence on the effectiveness of physical exercise and neurocognitive interventions grounded in cognitive–behavioral therapy (CBT) principles for the management of CRPS. A comprehensive search was conducted in Medline (via Ovid), LILACS, ScienceDirect, PEDro, OTseeker, and the Cochrane Central Register of Controlled Trials (CENTRAL). Eligible studies included clinical trials, cohort studies, and cross-sectional studies, whereas case reports, pediatric populations, and animal studies were excluded. Fifteen studies met the inclusion criteria. Results: The findings indicated that aerobic exercise was consistently associated with pain reduction and functional improvement. Neurocognitive interventions informed by CBT principles, such as mirror therapy and graded exposure, also demonstrated efficacy in decreasing pain and enhancing functional independence. Most studies supported the effectiveness of these approaches in the management of CRPS. Overall, both physical exercise and neurocognitive interventions grounded in CBT principles produced positive effects on pain modulation, physical function, and daily activity performance. Conclusions: These findings highlight the therapeutic potential of combining physical and psychologically informed interventions for the treatment of CRPS. Full article

Complex Regional Pain Syndrome (CRPS) type 1 is a painful and disabling localized syndrome with a pathogenesis that is still unclear. The last revised diagnostic criteria for CRPS-1 syndrome were developed in 2012 (the so-called Budapest criteria), based only on clinical features, while the presence of bone marrow edema (BME) and the response to treatments were completely absent. As BME is usually present on magnetic resonance imaging (MRI) in the early (“warm”) phase of CRPS-1, this criterion should be added as a necessary criterion to Budapest criteria. In addition, hyperalgesia and/or allodynia are also commonly present in the warm phase. Therefore, both of these symptoms should be included as essential criteria. Furthermore, the response to bisphosphonates may be another important parameter to add to the list of treatment options, as well as hyperbaric oxygen therapy. Finally, it must be clear that BME is not an exclusive finding of CRPS-1. Therefore, a correct clinical history and, if needed, further radiological studies and laboratory tests should be performed to avoid a false diagnosis. In this paper, the “Bone Marrow Edema Diagnosis and Therapeutic Treatment” Italian Group (GEODEIT) proposes a revision of Budapest’s criteria to make them more meaningful and effective in reaching a correct and quick diagnosis of the disease. Full article

Complex Regional Pain Syndrome (CRPS) is a chronic pain disorder with several sensory, autonomic, motor, and trophic symptoms. Diagnosis is based on clinical criteria like the Budapest Criteria, but there are limitations to those criteria, especially for pediatric cases and different clinical presentations. Technical testing—including laboratory tests, electrophysiological studies, sensory and autonomic function tests, and more advanced imaging—provides supportive, but not definitive, evidence. Biomarkers such as certain microRNAs, inflammatory mediators, and autoantibodies may offer the potential for improved diagnostic accuracy, although they have not yet been adequately validated. New imaging techniques, including ultrasound elastography and neuroimaging, have identified both peripheral and central pathophysiological changes in CRPS. We can improve our diagnosis of CRPS by integrating standardized clinical criteria with technical evaluations and biomarker improvements; this should serve to make diagnosis earlier, reduce diagnostic delay, and promote individualized treatment. Full article

Background/Objectives: Radial artery access (RAA) is widely used for catheter-based procedures due to its safety and convenience, but complex regional pain syndrome (CRPS) remains a rare, underrecognized complication—particularly in women. CRPS manifests as prolonged, severe pain and autonomic symptoms, often associated with nerve irritation near the carpal tunnel. This study aimed to evaluate whether modifying the puncture site to a high radial artery puncture (HRAP) reduces the risk of CRPS in patients undergoing transarterial micro-embolization (TAME) for frozen shoulder. Methods: We retrospectively reviewed 97 patients (47 women and 50 men) who underwent transarterial micro-embolization (TAME) via conventional RAA for frozen shoulder between February and June 2019. The occurrence of CRPS and vascular complications was recorded. All punctures were ultrasound-guided. Results: Among women treated via conventional RAA, five developed CRPS and one had radial artery occlusion. CRPS symptoms included intense puncture site pain (mean duration was 47 days), which severely impaired daily function. No complications occurred in men. Following the adoption of HRAP, no cases of CRPS, prolonged pain, or vascular complications were observed in the consecutive 101 women treated. Conclusions: Our findings suggest HRAP reduces CRPS risk by avoiding superficial nerve branches and targeting deeper arterial segments with fewer sensory structures. This ultrasound-guided modification is simple, does not require additional training, and may be widely applicable in both musculoskeletal and cardiovascular interventions. HRAP may help minimize neuropathic complications in broader patient populations. Full article

Complex regional pain syndrome (CRPS) is a disabling pain condition, which is distinct from other pain syndromes by the presence of autonomic dysfunction and regional inflammatory changes. Objectives: To explore the impact of pharmacological treatment strategies, specifically scheduled, on-demand dosing regimens versus lack of medical treatment, on pain-related and functional outcomes in rehabilitation for individuals with CRPS. Methods: A total of 32 participants with CRPS were assigned to three treatment groups depending on analgesic treatment during the course of complex rehabilitation. Pre- and post-rehabilitation assessments were conducted using validated measures, including the Numerical Rating Scale (NRS) for pain, the Short-Form McGill Pain Questionnaire (SF-MPQ), PainDETECT, the Disabilities of the Arm, Shoulder, and Hand (DASH), and the Lower Extremity Functional Scale (LEFS). Results: Significant improvements in pain and upper limb function (DASH scores) were observed across all groups (p < 0.05). No statistically significant changes were found in lower limb function (LEFS). Between-group comparisons revealed significant differences in post-treatment pain scores (SFMPQ-B), particularly between groups with a constant treatment regimen and those without treatment. Conclusions: There were no statistically significant changes compared to different treatment regimen groups. The constant treatment group showed slightly better average improvements in pain and disability compared to other groups. Statistically significant improvements in all CRPS patients were observed in pain-related and functional measures. Full article

Objectives: To investigate whether a Multimodal Rehabilitation Program (MRP) affects the change in visual–spatial abilities, especially attention, information-processing speed, visual–spatial learning, the severity of depression, and strategies for coping with pain in Complex Regional Pain Syndrome (CRPS) participants. Methods: The study was conducted between October 2021 and February 2023, with a 4-week rehabilitation program that included individual physiotherapy, manual and physical therapy, and psychological intervention such as psychoeducation, relaxation, and Graded Motor Imagery therapy. Twenty participants with CRPS and twenty healthy participants, forming a control group, were enlisted. The study was a 2-arm parallel: a CRPS group with MRP intervention and a healthy control group matched to the CRPS group according to demographic variables. Before and after, the MRP participants in the CRPS group were assessed for visual–spatial learning, attention abilities, severity of depression, and pain-coping strategy. The healthy control group underwent the same assessment without intervention before two measurements. The primary outcome measure was Reproduction on Rey–Osterrieth’s Complex Figure Test assessing visual–spatial learning. Results: In the post-test compared to the pre-test, the participants with CRPS obtained a significantly high score in visual–spatial learning (p < 0.01) and visual information-processing speed (p = 0.01). They made significantly fewer omission mistakes in visual working memory (p = 0.01). After the MRP compared to the pre-test, the CRPS participants indicated a decrease in the severity of depression (p = 0.04) and used a task-oriented strategy for coping with pain more often than before the rehabilitation program (p = 0.02). Conclusions: After a 4-week MRP, the following outcomes were obtained: an increase in visual–spatial learning, visual information-processing speed, a decrease in severity of depression, and a change in the pain-coping strategies—which became more adaptive. Full article

Background: Since the 1980s, numerous case reports have explored the use of intramuscular botulinum toxin (BoNT) for Complex Regional Pain Syndrome (CRPS), with significant variation in rationale, dosing, guidance techniques, and outcome measures. This narrative review aims to summarize published evidence on the use of intramuscular BoNT in patients with CRPS, including studies using earlier terminology such as reflex sympathetic dystrophy (RSD). Given the heterogeneous and largely anecdotal nature of the literature, this review is intended to map the existing landscape rather than conduct a formal analysis. Methods: The PubMed and EMBASE databases were searched in August 2024 using terms related to CRPS and botulinum toxin. Following abstract and full-text screening, 25 publications were included. Results: The included studies span single case reports, case series, and small cohorts, encompassing at least 96 individual CRPS patients treated with intramuscular BoNT. Reported outcomes were heterogeneous, and key treatment parameters—such as toxin type, target muscles, guidance technique, and dosing—were inconsistently reported. Conclusion: The evidence for intramuscular BoNT in CRPS remains limited and heterogeneous, preventing firm conclusions on its efficacy or safety. Its use may be considered in select cases, particularly those with disabling or painful focal dystonia or myofascial pain, but standardized prospective studies are needed to clarify its clinical role. Full article

Background: Spinal cord stimulation (SCS) is applied for managing chronic intractable pain, but the factors predicting its effectiveness have not been extensively researched. Our study aimed to identify clinical variables that can predict the outcome of SCS. Methods: The electronic medical records of patients who received SCS for chronic intractable pain at two large tertiary teaching institutions in South Korea from 2008 to 2022 were reviewed. A successful outcome was characterized by attaining at least a 50% reduction in pain on the numerical rating scale (NRS) assessed at 6 months. Multivariable analysis was used to investigate the correlation between outcomes of SCS and clinical variables. Results: Of the 213 patients, 108 (50.7%) experienced successful outcomes at 6 months after SCS implantation. At 6 months, both the positive and negative outcome groups had significantly lower NRS pain scores than at baseline. Multivariable analysis revealed that male gender (p = 0.023) was an independent predictor of positive SCS outcomes; conversely, longer pain duration (p = 0.011) was a negative predictor. No significant adverse events associated with SCS were observed throughout the six-month follow-up duration. Conclusions: SCS could be an effective treatment for chronic intractable pain, including complex regional pain syndrome (CRPS) and persistent spinal pain syndrome (PSPS). More successful outcomes may be expected in male patients with a shorter duration of pain. Additional research is required to enhance patient selection processes and to identify clinical characteristics that contribute to improved long-term outcomes. Full article

Background: Complex regional pain syndrome (CRPS) is a rare, chronic, painful, neurological, debilitating disorder. Despite the substantial impact on quality of life, diagnosis remains challenging due to its complex pathophysiology and subjective clinical criteria. This integrative review aims to synthesize current research on potential diagnostic biomarkers for CRPS. Methods: A systematic search was conducted using the PubMed and Scopus databases to identify relevant studies published until January 2025. Inclusion criteria focused on adult CRPS patients, with studies examining diagnostic or predictive biomarkers. Results: Key findings highlight the role of inflammatory and immune-related biomarkers, such as elevated levels of cytokines (IL-6, TNF-α), immune cell infiltration, and specific autoantibodies. Neuropeptides, including substance P and calcitonin gene-related peptide, were associated with pain sensitization in acute phases, though their levels normalized in chronic stages. Additionally, genetic and epigenetic markers, brain imaging, and neurophysiological alterations provided insights into CRPS pathogenesis, emphasizing the dynamic nature of these biomarkers across disease stages. Conclusions: This review underscores the need for further research to integrate these biomarkers into diagnostic frameworks, which could enhance early diagnosis and treatment strategies for CRPS. Full article

Background: Stellate Ganglion Blocks (SGB) involve injecting local anesthetic near the stellate ganglion, which includes the C6, C7, and T1 ganglia. This procedure induces a sympathetic blockade and has been employed to address various conditions, such as post-traumatic stress disorder (PTSD), ventricular arrhythmias, and chronic pain syndromes like complex regional pain syndrome (CRPS). Central to this case series is the exploration of SGB as a unified treatment for PTSD and chronic low back pain—two conditions linked by central sensitization. Case Series Overview: The study presents three female veterans with histories of PTSD, chronic low back pain, and myofascial pain. These patients had not responded to conventional treatments, including medications and interventional procedures. They underwent SGB with a combination of 10 mg preservative-free dexamethasone sodium phosphate, 4 mL preservative-free lidocaine 2% with epinephrine, and 1 mL preservative-free bupivacaine 0.25%. The procedure was well tolerated without adverse effects. All three patients experienced significant improvements. The first and third patients reported reductions in PTSD symptoms, low back pain, and myofascial pain. The second patient experienced relief from PTSD symptoms and prolonged reduction in myofascial pain. This case series is the first to document SGB’s effectiveness in treating chronic low back pain alongside PTSD. Conclusions: The findings suggest that SGB could be an effective therapy for chronic overlapping conditions like PTSD, chronic low back pain, and myofascial pain, all of which share central sensitization mechanisms. The literature supports the notion that these conditions involve both physical and psychiatric components potentially responsive to SGB. By targeting sympathetic hyperactivity and reducing norepinephrine levels, SGB may alleviate symptoms across these interconnected syndromes. This case series highlights the potential of SGB as a novel approach for managing comorbid PTSD and chronic pain conditions. Further research is warranted to confirm its efficacy and explore its broader applications in treating central sensitization-related disorders and chronic overlapping pain conditions (COPC), potentially responsive to sympathetic blockade. Full article

Background/Objectives: Complex regional pain syndrome (CRPS) is a primary pain condition that can develop in a limb after a trauma. Although the condition is rare, it may cause lifelong pain and disability. Evidence-based treatments are limited. Neurogenic inflammation induced by the release of neuropeptides, such as calcitonin gene-related peptide (CGRP), is thought to play an important role in the pathophysiology of CRPS. Recently, drugs targeting CGRP have proven to be effective and well tolerated in the treatment of migraine, but their efficacy in other pain conditions, including CRPS, is unclear. The aim of this study is to assess the efficacy of the anti-CGRP antibody fremanezumab on pain in CRPS. Methods: In this randomized, double-blind, placebo-controlled, proof-of-concept study, 60 adult patients with CRPS with a disease duration of 3–36 months are randomized to treatment for eight weeks with fremanezumab 225 mg or placebo administered subcutaneously at a 1:1 rate. The primary objective is to compare the change in pain intensity from baseline to the last week of treatment between fremanezumab and the placebo. Other objectives are to assess pain relief and differences in clinical signs between the groups and to examine if the effect can be predicted by CGRP biomarkers. Adverse events and blinding will also be assessed. Conclusions: If found effective, fremanezumab and other anti-CGRP antibodies may emerge as a mechanism-based treatment option for patients with CRPS, which could hopefully improve the overall care of patients with this devastating disease. Full article

Complex Regional Pain Syndrome (CRPS) is a debilitating pain disorder involving chronic inflammation, neural sensitization and autonomic dysfunction. Fascia, a highly innervated connective tissue, is increasingly recognized for its role in pain modulation, yet its contribution to CRPS remains underexplored. This narrative review synthesizes the current evidence on fascia’s involvement in CRPS pathophysiology and potential therapeutic strategies. A literature search was conducted in PubMed, Scopus and Web of Science, selecting studies on fascia, CRPS, inflammation, oxidative stress and autonomic dysfunction, with emphasis on recent experimental, anatomical and clinical research. Fascia contributes to CRPS through neuroinflammation, fibrosis and autonomic dysregulation. Its rich innervation facilitates peripheral and central sensitization, while inflammatory mediators drive fibrosis, reducing elasticity and exacerbating pain. Autonomic dysfunction worsens hypoxia and oxidative stress, fueling chronic dysfunction. Advances in sonoelastography provide new insights, while fascial manipulation and targeted therapies show promise in early studies. Fascia plays a key role in CRPS pathophysiology, yet its clinical relevance remains underexplored. Future research integrating imaging, molecular profiling and clinical trials is needed to develop evidence-based fascia-targeted interventions, potentially improving CRPS diagnosis and treatment. Full article

Background/Objectives: The pathophysiological mechanisms of temperature asymmetry differ between patients with warm and cold subtypes of Complex Regional Pain Syndrome (CRPS). Consequently, the response to lumbar sympathetic blocks (LSBs) and the resulting temperature improvement may vary between these two subtypes. We aimed to evaluate whether there was a significant difference in temperature elevation following sympathetic blocks in warm versus cold subtypes of CRPS. Methods: We calculated the temperature difference by analyzing forward-looking infrared (FLIR) thermal camera images of the affected extremity at pre-block and 5-min post-block time points. The primary outcome measure was that the mean temperature increase following LSB would be higher in the cold CRPS group than in the warm CRPS group. The secondary outcome measure was that the mean temperature elevation following the sympathetic block in the cold CRPS subtype would be at least 50% higher than in the warm CRPS subtype. Results: The study assessed warm and cold CRPS subtypes by analyzing temperature profiles from 90 lumbar sympathetic blocks performed on 34 patients. The temperature change in the affected extremity following LSB varied widely, with the highest increase observed in one patient at 10.99 °C. The cold CRPS patients demonstrated a higher mean temperature increase at the 5 min time point following LSB, averaging 3.37 °C in initial cases and 2.67 °C across all cases. In comparison, warm CRPS patients had lower mean increases of 0.58 °C in initial cases and 1.23 °C across all cases. Notably, the mean temperature rise in the cold CRPS group exceeded that of the warm CRPS group by more than 50%, meeting the secondary outcome goal. Conclusions: Our results indicated that patients with the cold subtype of CRPS tend to experience greater temperature improvements compared to those with the warm subtype after undergoing a sympathetic block. Therefore, our findings suggest that the criteria for determining the success of a sympathetic block should be revised to account for the cold and warm subtypes of CRPS. Full article