CRPS stands for Complex Regional Pain Syndrome
Synonyms: reflex sympathetic dystrophy syndrome, Sudeck's syndrome, causalgia, shoulder-hand syndrome, a.o.
German: CRPS, Morbus Sudeck, Sudeck Krankheit, Sudeck'sche Dystrophie, Sudeck-Dystrophie, Algodystrophie, Sympathalgie, Komplexes regionales Schmerzsyndrom, Sympathische Reflexdystrophie (SRD), Reflex Sympathetic Dystrophy Syndrome (RSD)
The CRPS is a chronic neurologic disease, which occurs after soft tissue or nerve injury, often in association with the fracture of an extremity. The old term "Sudeck's syndrome" is still frequently used to describe CRPS of type 1 named after its discoverer Paul Sudeck (1866-1945), a Hamburg-based surgeon.
The pathogenesis of CRPS is not completely understood, but appears to be associated with a diruption of the healing process of injured tissue. The occurrence of CRPS is not dependent on the severity of the injury; the injury can even be so insignificant that the patient doesn't remember it. As a result of the injury, a misregulation of the sympathetic nervous system occurs, which hinders the normal healing process and instead stimulates a circulus vitiosus of pain and subsequent reaction of the sympathetic nervous system.
CRPS occurs in about 1-2% of patients who have had fractures and in approximately 2-5% of patients after peripheral nerve injuries.
The CRPS symptoms are unspecific at the beginning and are often falsely interpreted and/or not seriously considered by the treating physician. CRPS is however a disease and not an indisposition. Typical symptoms of the disease are:
Advanced symptoms are:
The etiopathology is very different in individual patients. Mild forms of the disease can spontaneously decline after weeks. In other cases, the disease can assume intensity and eventually become so serious that normal lifestyles of patients are severely affected. Another form of etiopathology is the alternation between remission and exacerbation.
The classification in the degrees of severity is not always clearly demarcated, since the individual symptoms can overlap and the progression of the disease is interindividually very different.
There is no simple test procedure to ensure the diagnosis of CRPS. The diagnosis is determined mostly from the typical clinical picture. The additional procedures are:
The therapeutic procedure for CRPS is dependent on the severity of the disease pattern. The potential measures are much diversified, as there is no therapy approach available that delivers satisfactory results for it alone.
Ganglionic opioid analgesia (GLOA) at the ganglion stellatum with Buprenorphine (Temgesic®) - not to be mistaken for the stellatum blockade - is one of the most effective therapy approaches so far with good chances of healing. Unfortunately, it is not widely used so far.
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