Complex Regional Pain Syndrome Presentation and Management

Clinical Presentation

The American College of Physicians suggests that CRPS typically presents with excruciating pain that gradually increases in intensity and size in the affected limb, sometimes spreading to the contralateral limb 1
CRPS is characteristically made worse by touch or stimulation (allodynia), according to the Clinical Infectious Diseases guidelines 1, 2
The condition can be associated with hair loss, tissue changes, and skin discoloration at the site of pain, as reported in Clinical Infectious Diseases 1
CRPS usually follows an injury, often minor in nature, as stated in Clinical Infectious Diseases 1, 2

Functional limb weakness can occur in CRPS, presenting as decreased motor function that may appear flaccid, according to the Journal of Neurology, Neurosurgery and Psychiatry 3
Patients with CRPS may have difficulty with transfers and weight-bearing activities, standing and maintaining posture, and using the affected limb for stabilizing objects, as reported in the Journal of Neurology, Neurosurgery and Psychiatry 3
Motor symptoms in CRPS can include weakness that appears disproportionate to the initial injury, decreased active range of motion, and altered movement patterns, as stated in the Journal of Neurology, Neurosurgery and Psychiatry 3

The Journal of Neurology, Neurosurgery and Psychiatry suggests that CRPS is primarily a clinical diagnosis based on history of trauma or injury to the affected limb, evidence of autonomic dysfunction, and motor and trophic changes 3
Imaging studies like 3-phase bone scan can be helpful with reported sensitivity of 78% and specificity of 88%, as reported in Praxis Medical Insights 4
CRPS type 1 occurs without nerve injury, while CRPS type 2 occurs after nerve injury, according to Praxis Medical Insights 4

The Journal of Neurology, Neurosurgery and Psychiatry recommends that physical and occupational therapy are cornerstones of treatment, including encouraging optimal postural alignment and promoting even distribution of weight 3
Medication approaches may include anti-inflammatory agents, as suggested by Circulation 5
Patients should be evaluated at least twice annually by a vascular specialist due to the relatively high incidence of recurrence, as recommended by Circulation 5

The Journal of Neurology, Neurosurgery and Psychiatry suggests that in patients with flaccid limb presentation, it's essential to rule out other neurological causes of weakness 3
Patients with diabetes may present with severe CRPS and tissue loss but minimal pain due to concomitant neuropathy, as reported in Circulation 5