Postoperative complex regional pain syndrome

Abstract

Complex regional pain syndrome (CRPS) is a complex, multifaceted, disabling and disproportionate spectrum of pain, vasomotor, sudomotor and trophic changes resulting from surgical or traumatic injury. There is some evidence that CRPS may play a primary role in thoracic outlet syndrome (TOS) patients, but because surgery is so often provided as a treatment for TOS there is an increased overall risk of development of CRPS in this patient group to start with. The pathophysiology of CRPS involves peripheral neurogenic inflammation and an intricate interaction of peripheral and central mechanisms involving the somatosensory, somatomotor and autonomic nervous systems. Due to lack of a specific diagnostic test, diagnosis remains clinical and laboratory tests supportive. Clinical diagnosis is made by the presence of sensory, vasomotor, sudomotor, and motor/trophic symptoms and signs as defined by the "Budapest criteria". Treatment is challenging and a comprehensive approach including education, prevention, rehabilitation, psychotherapy, pharmacotherapy, and interventional modality seems logical. Early diagnosis, treatment and preemptive measures in high-risk patients are critical.