What is the clinical background of complex regional pain syndrome type 1 (CRPS 1) (RSD)?

Updated: Sep 09, 2018
  • Author: T P Sudha Rao, MD; Chief Editor: Herbert S Diamond, MD  more...
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Answer

Type 1 complex regional pain syndrome (CRPS 1), formerly known as reflex sympathetic dystrophy (RSD), is a clinical syndrome of variable course and unknown cause characterized by pain, swelling, and vasomotor dysfunction of an extremity. This condition is often the result of trauma or surgery. Limb immobility may lead to CRPS 1; in a hemiplegic upper limb after stroke, the syndrome is often termed shoulder-hand syndrome. CRPS 1 may also develop in the absence of an identifiable precipitating event.

Current taxonomy categorizes CRPS 1 as occurring in the absence of definable nerve injury. [1] Type 2 CRPS, causalgia, develops after nerve injury; the term causalgia was coined by Mitchell in 1864 and derives from the Greek for burning pain. In patients with either type 1 or type 2 CRPS, sympathetic mediation of the pain (ie, improvement with sympathetic blockade) may or may not be evident.

CRPS 1 is largely a clinical diagnosis (see Presentation and DDx). Two major approaches to the treatment of early CRPS 1 are sympathetic blockade and anti-inflammatory therapy. Surgical sympathectomy may be considered in patients with refractory CRPS 1 that had initially responded to sympathetic blockade. Spinal cord stimulation is another surgical option. (See Treatment and Medication.)

For discussion of all types of CRPS, see Complex Regional Pain Syndromes.


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