CRPS: A Long and Painful Road to Diagnosis

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CRPS is often delayed and subsequent orthopedic surgery often worsens the condition.
CRPS is often delayed and subsequent orthopedic surgery often worsens the condition.

Diagnosis of complex regional pain syndrome (CRPS) is often delayed and subsequent orthopedic surgery often worsens the condition, according to a retrospective study published in the Scandinavian Journal of Pain.1

Analyzing data for 55 patients, Ellen Jørum, MD, PhD, and colleagues from Oslo University Hospital found that the mean time delay to CRPS diagnosis was 4 years, and that orthopedic re-operations exacerbated 80% of cases.

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CRPS is a relatively rare condition with symptoms that mimic other conditions. The syndrome is dominated by constant, burning pain that is often disproportionate to the initial injury, and may also involve motor disability.

Although the debilitating form of chronic pain is typically triggered by an injury, surgery, or immobilization, some idiopathic cases have been reported. CPRS is usually confined to one limb, but can sometimes spread to other limbs or body parts.2

Debilitating Pain, Worsened By Surgery

The study population included 38 cases of CRPS with no definite nerve lesion (type 1, previously known as reflex sympathetic dystrophy), and 17 cases with a major nerve lesion (type 2, previously known as causalgia). EMG/neurography of the affected extremity provided measurements of motor function, including distal delay, conduction speed, and sensory tests.

Results showed that the mean time to CRPS diagnosis was 3.9 years (range, 6 months to 10 years). Initiating events included fractures, squeeze injuries, blunt injuries, stretch accidents, and surgery.

Many patients experienced debilitating pain — 81.5% were unable to work at all, and only 16.4% managed part-time hours. The majority (65.5%) needed help with all housekeeping activities; only 34.5% were able to participate to some degree. All had given up leisure activities and reported sleep problems.

A total of 27 patients (14 men and 13 women) underwent one to 12 surgeries over a period ranging from 6 months to several years after initial injury. The majority (81.5%; 22) reported subsequent worsening of pain; another 4 found that their pain was not altered, and only 1 reported improvement of pain.

Importantly, researchers also found that 17 of the 22 patients with worsened postsurgical pain (77%) could have been diagnosed with CRPS before surgery.

"Retrospectively, by an analysis of patients' reports, as well as documentation in their records, based on information of pain, sensory and autonomic dysfunction, a large majority of these patients had symptoms and signs compatible with a certain or probable CRPS prior to the first post-injury surgical procedure," the authors write.

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