How is posttraumatic neuralgia differentiated from 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

Many patients with posttraumatic neuropathy have pain but not the full clinical profile of CRPS type II. In these cases, pain is located largely within the territory of the injured nerve, which contrasts with patients with CRPS type II. Although patients with neuropathy often describe the pain as burning, they exhibit a less complex clinical picture than patients with CRPS type II and do not show marked swelling or the progressive spread of symptoms.

The principal symptoms for posttraumatic neuropathy are spontaneous burning pain, hyperalgesia, and mechanical allodynia. These sensory symptoms are confined to the territory of the affected peripheral nerve, although the allodynia may extend beyond the nerve territory's border by some centimeters. Both spontaneous and evoked pain is felt superficially, not deep inside the extremity, and the intensity of both is independent of the position of the extremity.

Patients with posttraumatic neuropathy usually obtain relief with sympatholytic procedures, although much less often than patients with CRPS. Following the IASP classification, it is possible to choose the term posttraumatic neuralgia for this type of neuropathic pain (pain within the territory of the lesioned nerve). However, the new definition of CRPS type II also includes the statement that symptoms can be limited to the territory of a single peripheral nerve. Therefore, the term CRPS type II could be applied to these localized posttraumatic neuropathies, even though they are different syndromes with different underlying mechanisms, which highlights the problems with this definition of CRPS II.


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