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Practice Practice Pointer

Complex regional pain syndrome

BMJ 2014; 348 doi: (Published 25 June 2014) Cite this as: BMJ 2014;348:g3683
  1. Fernanda B Fukushima, assistant professor1,
  2. Dailson M Bezerra, PhD student1,
  3. Paulo J F Villas Boas, associate professor2,
  4. Adriana P Valle, associate professor2,
  5. Edison I O Vidal, assistant professor2
  1. 1Anesthesiology Department, Universidade Estadual Paulista (UNESP), 18618-970, Botucatu, SP, Brazil
  2. 2Internal Medicine Department, Universidade Estadual Paulista (UNESP), 18618-970 , Botucatu, SP, Brazil
  1. Correspondence to: F B Fukushima ffukushima{at}
  • Accepted 7 April 2014

The authors explore how doctors in primary care can identify, approach, and refer patients with regional pain syndrome

Learning points

  • Complex regional pain syndrome (CRPS) is characterised by constant regional neuropathic pain that does not follow the usual distribution of a dermatome or nerve territory and is usually associated with abnormal sensory, autonomic, motor, and/or trophic changes

  • CRPS should be suspected in individuals reporting burning pain of an intensity that exceeds what would be generally expected from the triggering injury or that lasts beyond the usual healing time for injury

  • There are no specific tests to diagnose or exclude CRPS

  • Diagnosis relies almost exclusively on clinical assessment and is currently based on the Budapest criteria (see box 1)

  • The evidence base for the management of CRPS is limited, and treatment decisions are based on general principles of management of neuropathic and chronic pain

  • Patients with CRPS should be referred promptly to specialty pain clinics whenever symptoms are anything but mild or when there is functional impairment

Complex regional pain syndrome (CRPS) is characterised by constant regional neuropathic pain that is usually associated with abnormal sensory, autonomic, motor and/or trophic changes.1 Though it usually develops after trauma to a limb, in CRPS pain is disproportionate in time or intensity to the usual course of pain after injury. There are two subtypes of CRPS: in type I no overt nerve lesion can be identified; in type II definite nerve injury is evident.

CRPS has had various names including causalgia, reflex sympathetic dystrophy, Sudeck’s atrophy, algoneurodystrophy, and shoulder-hand syndrome. All those terms were replaced by CRPS after a 1993 conference by the International Association for the Study of Pain (IASP), which aimed at clarifying and providing more uniformity for diagnosis. Only recently has it begun to feature in more general medical textbooks, and most …

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