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Complex regional pain syndrome

Last reviewed: 14 Aug 2025
Last updated: 20 Nov 2024

Summary

Definition

History and exam

Key diagnostic factors

  • history of trauma
  • history of immobilization
  • female sex
  • chronic pain
  • limb pain with radiation
  • allodynia and hyperalgesia
  • body scheme changes
  • edema
  • trophic skin and nail changes
  • erythema or bluish appearance
  • local sweating changes or sweating asymmetry
  • muscle weakness
Full details

Other diagnostic factors

  • tremors
  • dystonic posturing
  • contractures
  • sensory loss in glove and stocking distribution
  • local changes in hair growth
  • skin bullae
Full details

Risk factors

  • trauma
  • immobilization
  • female sex
Full details

Diagnostic tests

1st tests to order

  • no test required: diagnosis is clinical
Full details

Tests to consider

  • electromyogram
  • nerve conduction studies with surface electrodes
  • punch skin biopsy
  • radiograph of affected limb
  • bone scintigraphy with technetium 99m
  • dual-energy x-ray absorptiometry (DXA)
  • quantitative CT scan
  • MRI
  • vascular studies
  • sympathetic nerve blocks
  • intravenous regional or selective anesthetic blocks
Full details

Emerging tests

  • autonomic testing

Treatment algorithm

ONGOING

early CRPS (within 6 months of onset)

chronic CRPS (>6 months since onset)

Contributors

Authors

Anuj Aggarwal, MD

Clinical Assistant Professor

Anesthesiology, perioperative and pain medicine

Stanford University

Redwood City

CA

Disclosures

AA declares that he has no competing interests.

Acknowledgements

Dr Anuj Aggarwal would like to gratefully acknowledge Dr Nicholas Shenker, Dr Gaurav Chhabra, and Dr Steven H. Horowitz, previous contributors to this topic.

Disclosures

NS is medical adviser to Cambridge Nutraceuticals with stock options. He has received consultancy fees from Roche to provide unrestricted sponsored educational meetings, and grants from Versus Arthritis, the National Institute for Health Research Clinical Research Network, and the Medical Research Council. NS is an author of references cited in this topic. GC has been sponsored by Medtronic, Boston Scientific, Abbott, Nevro, Stimwave, and Polar Medical for attending various conferences and cadaveric workshops relevant to pain medicine and neuromodulation. GC is an associate examiner for the European Society of Regional Anaesthesia & Pain Therapy European Diploma of Pain Medicine exam and is also the regional advisor for pain medicine for the South West Severn deanery. SHH declares that he has no competing interests.

Revisores

Andre Tomasino, MD

Department of Neurological Surgery

Weill Cornell Medical College

New York-Presbyterian Hospital

New York

NY

Declarações

AT declares that he has no competing interests.

Ari Weinreb, MD, PhD

Associate Chief of Rheumatology

VA Greater Los Angeles Healthcare System

Associate Professor of Medicine

David Geffen School of Medicine

UCLA

Los Angeles

CA

Declarações

AW declares that he has no competing interests.

Jonathan Berman, MBBS

Consultant in Pain Management and Anaesthesia

Pain Management Department

Royal National Orthopaedic Hospital NHS Trust

Middlesex

UK

Declarações

JB has been reimbursed by Pfizer for lectures given at Pfizer-sponsored meetings and courses.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

Merskey H, Bogduk N, eds. Classification of chronic pain: descriptions of chronic pain syndromes and definitions of pain terms. 2nd ed. Task force on Taxonomy of the International Association for the Study of Pain. Seattle, WA: IASP Press; 1994:39-43.

Goebel A, Birklein F, Brunner F, et al. The Valencia consensus-based adaptation of the IASP complex regional pain syndrome diagnostic criteria. Pain. 2021 Sep 1;162(9):2346-8.Texto completo  Resumo

Goebel A, Barker C, Birklein F, et al. Standards for the diagnosis and management of complex regional pain syndrome: results of a European Pain Federation task force. Eur J Pain. 2019 Apr;23(4):641-51.Texto completo  Resumo

Harden RN, McCabe CS, Goebel A, et al. Complex regional pain syndrome: practical diagnostic and treatment guidelines, 5th Edition. Pain Med. 2022 Jun 10;23(suppl 1):S1-53.Texto completo  Resumo

Cruccu G, Aziz TZ, Garcia-Larrea L, et al. European Federation of Neurological Societies (EFNS) guidelines on neurostimulation therapy for neuropathic pain. Eur J Neurol. 2007 Sep;14(9):952-70.Texto completo  Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
  • Complex regional pain syndrome images
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  • Guidelines

    • Complex regional pain syndrome: practical diagnostic and treatment guidelines, 5th edition​
    • Complex regional pain syndrome: practical diagnostic and treatment guidelines, 5th edition
    Mais Guidelines
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