What is the role of aberrant healing and inflammation in the pathophysiology of complex regional pain syndrome (CRPS)?

Updated: Jun 20, 2018
  • Author: Gaurav Gupta, MD; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Answer

After tissue injury, the body's response is programmed to promote healing, with the goal of regaining full use of the injured body part. Some experts have hypothesized that CRPS is caused by an aberrant healing response that includes exaggerated and persistent inflammation and guarding.

At the site of injury, peripheral C-fiber nociceptors transmit pain messages that cause ortho- and retrograde release of SP and CGRP into the damaged tissues, resulting in vasodilation, extravasation of pronociceptive mediators, reactivation and further sensitization of C-fiber afferents, and increased tissue comorbidity in the injured area. [14, 10] These neuropeptides prompt the physical signs of inflammation, including redness, warmth, and swelling, that are also commonly present in early CRPS. Also, algogenic substances are released, which increase nociception and initiate the process of peripheral sensitization previously discussed. Skin sensitivity and tenderness spread into adjacent regions, which are thought to be caused by secondary hyperalgesia from CNS alterations that are consistent with the described sensitization process.


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