Different Types of Pain in Complex Regional Pain Syndrome Require a Personalized Treatment Strategy

Abstract

Complex regional pain syndrome (CRPS) is a debilitating painful state of an extremity that can develop after trauma. CRPS is diagnosed by the new International Association for the Study of Pain (IASP) diagnostic criteria for CRPS. The syndrome is characterized by continuing regional pain with abnormal sensory, motor, sudomotor, vasomotor, edema, and/or trophic signs. The clinical presentation of CRPS can be very heterogeneous because CRPS is a multi-mechanism syndrome. Therefore, mechanism-based subgroups have been suggested to personalize treatment for CRPS. Additionally, the presentation of symptom pain may also be able to identify different subgroups of CRPS. In this review, the types of pain recognized by the IASP―nociceptive, neuropathic, and nociplastic pain―will be discussed as possible subgroups for CRPS. Each pain type should be identified in CRPS patients, with a thorough history taking, physical examination, and diagnostic tests or (novel) biomarkers to optimize treatment effectiveness. Over the course of the syndrome, patients with CRPS probably experience more than one distinct pain type. Therefore, pain specialists should be alert to not only adjust their treatment if underlying pathophysiologic mechanisms tend to change but also to personalize the treatment of the associated type of pain in the CRPS patient.

Keywords:

• CRPS
• nociceptive pain
• neuropathic pain
• nociplastic pain
• mixed pain
• personalized medicine

Abbreviations

COMPACT questionnaires, Core Outcome Measurement set for complex regional PAin syndrome Clinical sTudies;¹¹³ CRPS, Complex Regional Pain Syndrome; DN4, douleur neuropathique 4 questionnaire;⁴⁴ GABA, gamma-aminobutyric acid; IASP, International Association for the Study of Pain; MRI, magnetic resonance imaging; NMDA, N-Methyl-D-aspartic acid; PainDETECT, pain detect questionnaire;⁴³ WHO analgesic ladder, World Health Organization analgesic ladder.³⁸.

Disclosure

Prof. Dr. FJPM Huygen reports personal fees for educational work and grants from ABBOTT, Saluda, and Boston Scientific outside the submitted work. Prof. Dr. Frank JPM Huygen also has patents P121304EP00 and P121304NL00 pending to DRG stimulation for spasticity. The authors report no other conflicts of interest in this work.

Additional information

Funding

No funding for this research has been received.