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Am J Hosp Palliat Care 2019 Mar 27:1049909119838974. Epub 2019 Mar 27.

2 Hospice and Palliative Medicine, Ballad Health System, Kingsport, TN, USA.

Pain can have a devastating effect on the quality of life of patients in palliative medicine. Thus far, majority of research has been centered on opioid-based pain management, with a limited empirical evidence for the use of nonopioid medications in palliative care. However, opioid and nonopioid medications such as nonsteroidal anti-inflammatory drugs have their limitations in the clinical use due to risk of adverse effects, therefore, there is a need for more research to be directed to finding an alternative approach to pain management in comfort care setting. Read More

Neurosurg Clin N Am 2019 Apr 18;30(2):169-194. Epub 2019 Feb 18.

Department of Neurosurgery, Albany Medical College, 43 New Scotland Avenue, Albany, NY 12208, USA; Department of Neuroscience and Experimental Therapeutics, Albany Medical College, 43 New Scotland Avenue, Albany, NY 12208, USA. Electronic address:

Spinal cord stimulation (SCS) has been well established as a safe and effective treatment of pain derived from a wide variety of etiologies. Careful patient selection including a rigorous trial period and psychological evaluation are essential. When patients proceed to permanent implantation, various considerations should be made, such as the type of lead, type of anesthesia, and waveform patterns for SCS. Read More

F1000Res 2019 5;8. Epub 2019 Mar 5.

Department of Medicine, Monash University, Clayton, Victoria, 3168, Australia.

The common chronic pain syndromes of fibromyalgia, regional pain syndrome, and complex regional pain syndrome have been made to appear separate because they have been historically described by different groups and with different criteria, but they are really phenotypically accented expressions of the same processes triggered by emotional distress and filtered or modified by genetics, psychology, and local physical factors. Read More

Reg Anesth Pain Med 2019 Mar;44(3):376-387

Department of Pain Management, Cleveland Clinic, Cleveland, OH 44024, USA

This account of the condition now termed complex regional pain syndrome (CRPS) spans approximately 462 years since a description embodying similar clinical features was described by Ambroise Paré in 1557. While reviewing its historical origins, the text describes why it became necessary to change the taxonomies of two clinical syndromes with similar pathophysiologies to one which acknowledges this aspect but does not introduce any mechanistic overtones. Discussed at length is the role of the sympathetic component of the autonomic nervous system (ANS) and why its dysfunction has both directly and indirectly influenced our understanding of the inflammatory aspects of CRPS. Read More

Medicine (Baltimore) 2019 Feb;98(7):e14452

Department of Psychiatry, Seoul National University Hospital.

Complex regional pain syndrome (CRPS) and fibromyalgia (FM) share many features. Both can cause severe pain and are considered to have a mechanism of action, including dysfunction of the sympathetic nervous system. However, they have clinical differences in pain range and degree. Read More

Pain 2019 Feb 8. Epub 2019 Feb 8.

Department of Endocrine Research, Medical Hospital I, BG University Hospital Bergmannsheil Bochum, Bochum, Germany.

Local osteopenia and altered bone metabolism are major complications of complex regional pain syndrome (CRPS), but quantitative assessment is difficult unless using X-ray or dual-energy X-ray absorptiometry. Ultrasound-based measurement of bone density (UBD) is a possible alternative but has never been used to detect unilateral disease such as CRPS. Therefore, the main outcome measure of this prospective study was the diagnostic utility of UBD in patients with lower-limb CRPS. Read More

Medicine (Baltimore) 2019 Feb;98(5):e14282

Department of Anesthesiology and Pain Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

Pulsed radiofrequency (PRF) to the thoracic sympathetic ganglion (TSG PRF) or to the cervical sympathetic chain (CSC PRF) can be performed to overcome transient effects of single sympathetic blocks in patients with upper-extremity complex regional pain syndrome (CRPS).We retrospectively compared the clinical effects of TSG PRF and CSC PRF. Seven TSG PRF cases and 10 CSC PRF cases were enrolled in the present analysis. Read More

Br J Pain 2019 Feb 13;13(1):35-42. Epub 2018 Jun 13.

SI 'Institute of Traumatology and Orthopedics of the Academy of Medical Sciences of Ukraine', Kyiv, Ukraine.

Introduction: Mirror therapy requires a minimum of equipment, is relatively simple to perform and effective for various pathological conditions. The effect of mirror therapy on body schema disturbances registered in complex regional pain syndrome type I (CRPS I) patients has not yet been determined.

Methods: The study is based on the analysis of the treatment results of 30 patients with CRPS I, developed as a result of the distal radius fractures, with help of mirror therapy together with exercise therapy and medications. Read More

Toxicon 2019 Mar 17;159:41-44. Epub 2019 Jan 17.

Department of Physical and Rehabilitation Medicine, University of Padova, Via Giustiniani 3, 35128, Padova, Italy.

Complex regional pain syndrome (CRPS) is characterized by hyperalgesia, autonomic and trophic alterations of bones, muscles and skin. It is supported by neurogenic inflammation and impairment of sympathetic nervous system. Botulinum Toxin (BTX) is an option for the management of pain, with level B evidence of efficacy in neuropathic, joint and myofascial pain syndrome. Read More

Autoimmun Rev 2019 Mar 11;18(3):270-278. Epub 2019 Jan 11.

Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis School of Medicine, United States. Electronic address:

Complex regional pain syndrome (CRPS) has been considered to be an autoimmune disease and there have been clinical trials with intravenous immunoglobulin. Often the etiology of the so-called CRPS diagnosis cannot be discerned and there are no validated instruments that provide functional metrics. The term complex regional pain syndrome (CRPS), coined in 1994 to describe patients in whom the pain is out of proportion to the injury, was actually a diagnosis proposed during the American Civil War, but was originally known as causalgia. Read More

Zhen Ci Yan Jiu 2018 Nov;43(11):733-7

1Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen 518000, Guangdong Province, China; 2Clinical Medical College of Acu-moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou 510405.

Objective: To analyze the factors influencing the therapeutic effect of "Shoulder Tri-needles therapy" in the treatment of shoulder-hand syndrome of stroke patients by using machine learning approach, so as to provide a feasibility for improving clinical efficacy.

Methods: A total of 586 stroke patients with shoulder-hand syndrome eligible for this study were involved in our machine learning experiments for classification of the influential factors. Their data including the age, gender, pulse condition, complexion, tongue quality, tongue coating, disease stage, body mass index (BMI), blood pressure, blood glucose, blood triglyceride, blood total cholesterol, smoking history, drinking history, and final outcomes were extracted from the medical record system (from Oct. Read More

Transplant Proc 2018 Dec 8;50(10):4090-4095. Epub 2018 Sep 8.

Department of Pharmacy, Tianjin First Central Hospital, Tianjin, China.

Background: Calcineurin-inhibitor-induced pain syndrome (CIPS), a rare complication seen in patients with bone marrow transplants, is associated with the use of cyclosporine A (CsA) or tacrolimus (FK506). This case demonstrates the successful pain control of FK506-related CIPS in a 23-year-old male patient with previously reported characteristic clinical features of CIPS in addition to neuropathic symptoms and uncharacteristic imaging findings. On day 15 after the transplantation, the patient complained of severe pain in the lower limbs. Read More

Medicine (Baltimore) 2018 Dec;97(50):e13272

Division of Pain Medicine, Department of Anesthesiology, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York.

Rationale: Continuous epidural infusion of local anesthetic may be an alternative to sympathetic blocks in refractory cases of complex regional pain syndrome (CRPS). Spinal epidural abscess (SEA) is a well-known complication associated with this technique, especially in patients with immune deficiencies. We herewith report a cervical SEA associated with an epidural catheter in a woman with CRPS and selective IgG3 subclass deficiency. Read More

Neurotherapeutics 2019 Jan;16(1):9-25

Division of Plastic and Reconstructive Surgery, Washington University in St. Louis, St. Louis, MO, USA.

Pain is a frequent cause of physician visits. Many physicians find these patients challenging because they often have complicated histories, emotional comorbidities, confusing examinations, difficult problems to fix, and the possibility of factitious complaints for attention or narcotic pain medications. As a result, many patients are lumped into the category of chronic, centralized pain and relegated to pain management. Read More

Plast Reconstr Surg Glob Open 2018 Oct 16;6(10):e1847. Epub 2018 Oct 16.

Elite Plastic Surgery, Phoenix, Arizona.

Background: Complex regional pain syndromes (CRPS) is a disease that is poorly understood. It is a chronic pain syndrome characterized by sympathetic disruptions as well as CNS sensitization. Botulinum Toxin-A has been shown to have efficacy in Raynaud's as well as other neuropathic pain disorders. Read More

Neuroreport 2019 01;30(2):108-112

Emotional Information and Communication Technology Association, Seoul, Republic of Korea.

The aim of this study was to investigate distinct neurometabolites in the right and left thalamus and insula of patients with complex regional pain syndrome (CRPS) compared with healthy controls using proton magnetic resonance spectroscopy. Levels of N-acetylaspartate (NAA), N-acetylaspartylglutamate (NAAG), myo-inositol (ml), glutamine (Gln), glycerophosphocholine (GPC), glutathione (GSH), and alanine (Ala) relative to total creatine (tCr) levels, including creatine and phosphocreatine, were determined in the right and left thalamus and insula in 12 patients with CRPS compared with 11 healthy controls using magnetic resonance spectroscopy. Levels of NAAG/tCr and Ala/tCr were higher in patients with CRPS than in controls in the left thalamus. Read More

Am J Case Rep 2018 Nov 19;19:1373-1377. Epub 2018 Nov 19.

Department of Psychology, University of New Mexico, Albuquerque, NM, USA.

BACKGROUND Both spinal cord stimulators (SCS) and interdisciplinary chronic pain rehabilitation program (CPRP) are evidence-based treatments for chronic pain but differ on treatment foci. SCS focuses on decreasing the subjective pain experience as a means of improving function and quality of life. CPRP focuses on addressing the cognitive, emotional, and behavioral factors associated with chronic pain to improve function. Read More

J Hand Surg Asian Pac Vol 2018 Dec;23(4):554-561

* Department of Occupational Therapy, The University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.

Background: To investigate the role of psychological factors (anxiety and depression) and pain measured on a visual analogue scale (VAS) in the development of complex regional pain syndrome type I (CRPS I) following the distal radius fracture (DRF).

Methods: A consecutive sample of patients (N=60) with a distal radius fracture was measured for signs of CRPS by Budapest criteria weekly till 8 weeks and then another follow-up one year after injury to determine the incidence and predictors of developing CRPS I in a prospective cohort study and also to discover whether there is difference between pain, depression, and anxiety level in the patients with and without CRPS I. The most of the patients were treated by Pin stabilization. Read More

Pain Res Manag 2018 17;2018:2894360. Epub 2018 Oct 17.

Department of Anaesthesiology and Intensive Care Medicine, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany.

Background: Complex regional pain syndrome (CRPS) is a multifactorial disorder with complex aetiology and pathogenesis. At the outpatient pain clinic of Magdeburg University Hospital, all patients, without exception, are subject to permanent psychiatric care delivered by a consultation-liaison psychiatrist. In CRPS, psychological stabilization and treatment of the neuropathic aspects are equally important. Read More

Medicine (Baltimore) 2018 Nov;97(45):e13115

Department of Anesthesia, St. Joseph's Hospital, McMaster University, Hamilton, Ontario, Canada.

Rationale: Ehlers-Danlos syndromes (EDSs) are a heterogeneous group of heritable connective tissue disorders involving defective collagen synthesis. Patients with EDS are prone for chronic myofascial pain, apart from other comorbidities. Although the initial pathology is commonly nociceptive, progression of EDS leads to neuropathies and central sensitization of pain signals. Read More

Med Hypotheses 2018 Dec 29;121:15-20. Epub 2018 Aug 29.

Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB Groningen, The Netherlands.

Deciding for an amputation in case of complex regional pain syndrome type I (CRPS-I) is controversial. Evidence for favorable or adverse effects of an amputation is weak. We therefore follow a careful and well-structured decision making process. Read More

Pain Manag 2018 Nov 5;8(6):427-436. Epub 2018 Nov 5.

Institute for Pain Medicine/Pain Practice Wiesbaden, Germany.

Aim: The secretolytic drug ambroxol may be useful for the treatment of neuropathic pain due to its multiple modes of action. We hypothesized that ambroxol may be a treatment option for complex regional pain syndrome (CRPS).

Methods: Additional to standard therapy, eight CRPS-patients with symptoms of less than 12 months were treated with topical 20% ambroxol cream. Read More

Mol Pain 2018 Jan-Dec;14:1744806918815005. Epub 2018 Nov 5.

1 Department of Anesthesiology, University of California, San Diego, La Jolla, CA, USA.

Complex regional pain syndrome is an extremely painful condition that develops after trauma to a limb. Complex regional pain syndrome exhibits autoimmune features in part mediated by autoantibodies against muscarinic-2 acetylcholine (M2) receptor. The mechanisms underlying the M2 receptor involvement in complex regional pain syndrome remain obscure. Read More

J Clin Apher 2018 Dec 2;33(6):661-665. Epub 2018 Nov 2.

Clinical Ethics, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom.

Background: Complex regional pain syndrome (CRPS) is a severe post-traumatic chronic pain condition affecting distal limbs, for which few effective treatments exist. Complex regional pain syndrome is listed in the 2016 American Society for Apheresis guidelines as an indication for plasma exchange treatment, but patient perspectives are lacking.

Study Design And Methods: We convened a "patient and public consultation exercise. Read More

Neuromodulation 2019 Feb 31;22(2):194-199. Epub 2018 Oct 31.

Department of Neurosurgery, Albany Medical Center, Albany, NY, USA.

Introduction: Preoperative work-up for spinal cord stimulation (SCS) includes a psychological assessment; however, no one psychological factor has correlated with poor outcomes across studies. We developed a Psychological Evaluation Tool for Spinal Cord Stimulation Candidacy (PETSCSC), which includes all factors in the literature found to correlate with outcomes. In this study, we examine whether PETSCSC correlates with postoperative outcomes. Read More

Neuromodulation 2019 Jan 25;22(1):44-52. Epub 2018 Oct 25.

University Hospital Bonn, Rheinische Friedrich-Wilhelms-University Bonn, Bonn, Germany.

Objectives: Complex regional pain syndrome (CRPS) and associated comorbidities have been linked to a pro-inflammatory state driven by different mediators. Targeted dorsal root ganglion stimulation (DRG ) suppressed pain levels and improved functional capacity in intractable CRPS. However, clinical trials assessing the impact of DRG stimulation on the neuroimmune axis are lacking. Read More

PLoS One 2018 22;13(10):e0206141. Epub 2018 Oct 22.

Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Québec, Canada.

There is a large body of evidence showing substantial sensorimotor reorganizations after an amputation. These reorganizations are believed to contribute to the development of phantom limb pain, but alternatively, pain might influence the plasticity triggered by the deafferentation. The aim of this study was to test whether pain impacts on deafferentation-induced plasticity in the somatosensory pathways. Read More

Br J Anaesth 2018 Nov 24;121(5):1133-1137. Epub 2018 Aug 24.

Department of Anesthesiology and Pain Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. Electronic address:

Background: Discrepancy between a patient's subjective thermal symptoms and objective measured temperature value is common in complex regional pain syndrome (CRPS) in clinical settings. For that reason, the diagnostic validity of a single temperature measurement method has been criticised. Several studies showed that the perfusion index (PI), which is derived from pulse oximetry, is a more sensitive and earlier indicator of sympathetic blockade than temperature measurement. Read More

BMJ Case Rep 2018 Oct 16;2018. Epub 2018 Oct 16.

USAT College of Medicine, University of Science, Arts & Technology, Olveston, Montserrat.

A 34-year-old man with a history of gunshot wound (GSW) to the right upper chest developed secondary aortic valve endocarditis (AVE) and was treated with an artificial valve placement (AVP). Three months after, he presented to an outpatient pain management clinic right arm pain and was diagnosed with complex regional pain syndrome type II (CRPS II). The patient underwent a diagnostic sympathetic ganglion block, before undergoing endoscopic thoracic sympathectomy surgery. Read More

N Engl J Med 2018 Oct;379(16):1575-1577

Pain Pract 2019 02 5;19(2):168-175. Epub 2018 Nov 5.

Department of Pain Medicine, BG University Hospital Bergmannsheil GmbH, Ruhr University, Bochum, Germany.

Background: The early phase of complex regional pain syndrome (CRPS) is characterized by an inflammatory state and therefore often treated with anti-inflammatory acting glucocorticoids. Recently, we demonstrated that remote ischemic conditioning (RIC), a cyclic application of nondamaging ischemia on a remote extremity, reduces blood flow and increases oxygen extraction in the CRPS-affected extremity.

Aim: The aim of the presented study was to analyze the effect of short-term pain treatment including glucocorticoid pulse treatment on the RIC-induced perfusion parameters. Read More

Neuromodulation 2019 Jan 24;22(1):1-35. Epub 2018 Sep 24.

Evidence-Based Pain Management Research and Education, Cleveland Clinic, Cleveland, OH, USA.

Introduction: The Neuromodulation Appropriateness Consensus Committee (NACC) is dedicated to improving the safety and efficacy of neuromodulation and thus improving the lives of patients undergoing neuromodulation therapies. With continued innovations in neuromodulation comes the need for evolving reviews of best practices. Dorsal root ganglion (DRG) stimulation has significantly improved the treatment of complex regional pain syndrome (CRPS), among other conditions. Read More

Musculoskelet Sci Pract 2018 12 5;38:15-22. Epub 2018 Sep 5.

Department of Psychological Medicine, University of Otago, Christchurch, Corner of Riccarton and Hagley Avenues, Christchurch 8042, New Zealand. Electronic address:

There are no validated clinical models to show a reliable pathway of guaranteeing an effective recovery for Complex Regional Pain Syndrome (CRPS) with physiotherapy management. An array of medical, psychological and physiotherapy intervention methods show weak benefit. Spearman correlations, with significance p < 0. Read More

Inflamm Res 2019 Jan 28;68(1):1-6. Epub 2018 Aug 28.

Department of Anesthesiology, Ludwig-Maximilians-Universität München (LMU), Marchioninistr. 15, 81377, Munich, Germany.

The aim of this study was to investigate T-cell subsets and immunomodulatory factors in patients with complex regional pain syndrome (CRPS). We found decreased numbers of pro-inflammatory Th17 cells in patients with CRPS as compared to healthy volunteers. The expression of Th17 related RORγT mRNA was also significantly decreased. Read More

Mol Pain 2018 Jan-Dec;14:1744806918799127. Epub 2018 Aug 20.

3 Palo Alto Veterans Institute for Research, Palo Alto, CA, USA.

Complex regional pain syndrome (CRPS) is a highly enigmatic syndrome typically developing after injury or surgery to a limb. Severe pain and disability are common among those with chronic forms of this condition. Accumulating evidence suggests that CRPS may involve both autoinflammatory and autoimmune components. Read More

Med Hypotheses 2018 Oct 29;119:41-53. Epub 2018 Jul 29.

Hunter Pain Clinic, 91 Chatham Street, Broadmeadow, NSW 2292, Australia.

Complex Regional Pain Syndrome (CRPS) has defied a clear unified pathological explanation to date. Not surprisingly, treatments for the condition are limited in number, efficacy and their ability to enact a cure. Whilst many observations have been made of physiological abnormalities, how these explain the condition and who does and doesn't develop CRPS remains unclear. Read More

Plast Reconstr Surg 2018 11;142(5):1251-1257

Indianapolis, Ind. From the Division of Plastic Surgery, Indiana University School of Medicine.

Background: Hand surgery dogma suggests that simultaneous surgical treatment of carpal tunnel syndrome and Dupuytren's contracture results in an increased incidence of complex regional pain syndrome. As a result, many surgeons do not perform surgery for the two conditions concurrently. The authors' goal was to determine the extent of this association. Read More

Nurs Clin North Am 2018 09;53(3):349-360

Department of Anesthesia, Wooden Anesthesia PC, Boone County Medical Center, 406 S 8th Street, Albion, NE 68620, USA.

Management of chronic pain has become a significant challenge for primary care providers, and the population of patients with chronic pain is expected to increase. Common syndromes seen in the primary care setting include myofascial pain syndrome, fibromyalgia, chronic postsurgical pain, complex regional pain syndrome, and painful diabetic neuropathy. This article describes these syndromes and presents current treatment options. Read More

PLoS One 2018 9;13(8):e0201354. Epub 2018 Aug 9.

Center for Rehabilitation of Pain Syndromes, Reuth Rehabilitation Hospital, Tel Aviv, Israel.

Objective: Complex Regional Pain Syndrome (CRPS), a chronic pain condition, develops mainly after limb trauma and severely inhibits function. While early diagnosis is essential, factors for CRPS onset are elusive. Therefore, identifying those at risk is crucial. Read More

Rev Neurol (Paris) 2018 Dec 24;174(10):671-674. Epub 2018 Jul 24.

Unité de soins intensifs neuro-vasculaires et réseau bourgogne-AVC, CHU de Dijon Bourgogne, 14, rue Paul-Gaffarel, 21079 Dijon cedex, France.

Pain after stroke (PAS) is a common clinical problem that is both underdiagnosed and undertreated. Yet, it induces depression and cognitive troubles, and impairs quality of life. To provide tools for practitioners, this report describes the most common PAS syndromes, including central post-stroke pain, spasticity and contractures, shoulder pain and complex regional pain syndromes, as well as headache and chondrocalcinosis, along with their risk factors, their prevention and their specific treatments. Read More

World Neurosurg 2018 Nov 23;119:e235-e243. Epub 2018 Jul 23.

Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea.

Objective: The aim of this study is to determine the risk factors affecting intraoperative neurophysiologic monitoring (IONM) changes, when such changes take place, and clinical outcomes associated with IONM change during cervical open door laminoplasty (COL) for cervical compressive myelopathy.

Methods: Between 2010 and 2015, 79 patients who underwent COL with IONM recording were studied. Changes in motor evoked potentials or somatosensory evoked potentials over an alarm criterion were defined as IONM change. Read More

Int J Technol Assess Health Care 2018 Jan 26;34(4):400-409. Epub 2018 Jul 26.

Department of Clinical Psychological Science,Maastricht University CAPHRI - School for Public Health and Primary Care, Department of Rehabilitation Medicine, Maastricht University.

Objectives: The aim of this study was to evaluate the cost-effectiveness of exposure in vivo (EXP, a cognitive-behavioral treatment targeting pain-related fear) in Complex Regional Pain Syndrome Type I (CRPS-I), as compared to pain-contingent physical therapy (PPT).

Methods: Data from a randomized controlled trial were used to compare the cost-effectiveness of EXP versus PPT from a societal perspective. Intervention costs, other healthcare costs, costs to patient and family, and productivity losses were included. Read More

Ann Rheum Dis 2018 Oct 14;77(10):1397-1404. Epub 2018 Jul 14.

Rheumatology Department, Regional Center for Autoimmune and Rheumatic Diseases (Centro Regional de Enfermedades Autoinmunes y Reumaticas, CREAR), Rosario, Santa Fe, Argentina.

Epidemiological studies in Latin America suggest indigenous people lack proper healthcare for musculoskeletal (MSK) and rheumatic diseases.

Objectives: This study aimed to estimate the prevalence of MSK disorders and rheumatic diseases in eight Latin American indigenous communities, and to identify which factors influence such prevalence using network analysis and syndemic approach.

Methods: This is a cross-sectional, community-based census study according to Community-Oriented Program for the Control of Rheumatic Diseases methodology. Read More

Medicine (Baltimore) 2018 Jul;97(28):e11492

Rationale: Evidence from cadaveric studies note that the sympathetic nerves from the second and third thoracic ganglia bypass the stellate ganglion in 20% of the population. We present a novel alternative technique for sympathetic blockade of upper extremity via thoracic epidural approach.

Patient Concerns: The patient-reported anxiety about "the placement of the needle in the front of the neck" and severe pain secondary to complex regional pain syndrome. Read More

Pain 2018 Nov;159(11):2296-2305

Danish Pain Research Center, Aarhus University Hospital, Aarhus, Denmark.

The aim of this study was to determine whether upregulated cutaneous expression of α1-adrenoceptors (α1-AR) is a source of pain in patients with complex regional pain syndrome (CRPS). Immunohistochemistry was used to identify α1-AR on nerve fibres and other targets in the affected and contralateral skin of 90 patients, and in skin samples from 38 pain-free controls. The distribution of α1-AR was compared between patients and controls, and among subgroups of patients defined by CRPS duration, limb temperature asymmetry, and diagnostic subtype (CRPS I vs CRPS II). Read More

Medicine (Baltimore) 2018 Jun;97(26):e11301

Department of Psychiatry, Hofstra Northwell Health-Staten Island University Hospital, Staten Island, New York.

Rationale: To present an unusual extrapyramidal motor response occurring after a sympathetic block in CRPS and its successful treatment with diphenhydramine.

Patient Concerns: Severe pain related to Complex Regional Pain Syndrome type 1 interfering with activities of daily living.

Diagnoses: Complex Regional Pain Syndrome type 1. Read More

BMC Musculoskelet Disord 2018 Jun 26;19(1):202. Epub 2018 Jun 26.

Department of Orthopaedic Surgery, Medical School, University of Minnesota, Minneapolis, MN, USA.

Background: Distal radius fractures (DRF) account for nearly one-fifth of all fractures in older adults, and women experience them 5× as often as men. Most DRF occur with low impact injuries to the wrist with an outstretched hand, and are often managed via closed treatment and cast immobilization. Women sustaining a DRF are at risk for upper limb immobility, sensorimotor changes, edema and type I complex regional pain syndrome (CRPS). Read More

Scand J Pain 2013 Jan 1;4(1):3-7. Epub 2013 Jan 1.

Center for Cancer Treatment, Sørlandet Hospital Trust, Kristiansand, Norway.

Background Neuropathic pain remains a significant challenge with unsatisfactory therapeutic options. Its pathogenesis may involve the neuropathic triad of neuronal, glial and immune cells. Communication between these cells is possibly perpetuated by mitogen-activated protein kinase (MAPK)-signaling. Read More

Scand J Pain 2013 Oct 1;4(4):200-207. Epub 2013 Oct 1.

Pain Center, Department of Anesthesia and Intensive Care, Akademiska sjukhuset, Uppsala, Sweden.

Background and purpose This case of a 42 year old woman with lower extremity Complex Regional Pain Syndrome (CRPS) after a twisting injury of the ankle, effectively treated with the addition of mirror therapy to a rehabilitation programme, prompted a literature review of both CRPS and mirror therapy. Mirror therapy is a newer adjunct to other forms of pain control and functional restoration for treatment of CRPS as well as other difficult clinical problems. This was a required group project as part of a university based course in chronic pain for healthcare workers. Read More

Clin Neurol Neurosurg 2018 Aug 10;171:156-162. Epub 2018 Jun 10.

Department of Neurosurgery - Neurological and Neurosurgical Clinic of Joinville, Brazil. Electronic address:

Objective: Spinal cord stimulation has been proven highly effective in the treatment of Complex Regional Pain Syndrome (CRPS). The definitive implantation of a neurostimulator is usually preceded by a therapeutic test (trial), which has the purpose of identifying whether the patient would respond positively to neuromodulation or not. The present study aims to analyze the surgical results of spinal cord stimulation in type 1 CRPS patients who have not undergone trial. Read More