Osteo-Cutaneous Trophic Changes in Complex Regional Pain Syndrome and their Reversal with Steroids.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: None 16. Z Orthop Unfall. 2023 Jun;161(3):337-352. doi: 10.1055/a-1898-2454. Epub 2023 Jun 12. [Complex Regional Pain Syndrome (CRPS) - State of the Art in Diagnostics and Therapy]. [Article in German] Papenhoff MC, Habig K, Schmitz C, Lundin S, Schreier D, Tineghe J, Dudda M. The complex regional pain syndrome (CRPS) usually occurs within a few weeks in 2-5% of all patients after trauma or surgery or subsequent measures of the distal extremities. There are certain risk factors for its occurrence but no "CRPS personality", instead there are factors that negatively influence the course. The prognosis is generally good ("rule of thirds"), but remaining limitations are common. The diagnosis is clinically possible according to the "Budapest criteria". Additional examinations are possible in case of doubt but are neither conclusive nor exclusive. Corticoids and bisphosphonates are used alongside drugs that have an effect on neuropathic pain. Invasive therapies do not have good evidence and have therefore lost their importance. The rehabilitative therapy is carried out actively and with a lot of self-exercises at an early stage. Invasive anesthetic, passive therapies are obsolete. Special forms of treatment are "graded exposure" (GEXP) in the case of dominant anxiety and, e.g., "graded motor imagery" (GMI) in case of neglect-like symptoms. In addition to educational and behavioral therapy elements, psychotherapy for CRPS also includes participation as part of graded exposure. Thieme. All rights reserved. DOI: 10.1055/a-1898-2454