Síndrome de dolor regional complejo

Abstract

Complex regional pain syndrome (CRPS) is a painful disorder, classified in two types depending on whether no nerve lesion has been detected (type I) or whether a nerve lesion is present (type II). CRPS usually develops after a noxious event (trauma injury or surgery), but can sometimes appear spontaneously, and genetic factors may predispose to CRPS. Several etiopathogenic concepts have been proposed, such as neurogenic inflammation, pathological sympathetic activation and neuroplastic changes in the central nervous system. Diagnosis is mainly based on clinical symptoms and signs, such as autonomic, motor and sensory disturbances. The most common and early symptom is pain, as well as distal edema, sweating, disturbances of skin temperature and color, hyperalgesia, motor weakness and, in chronic phases, skin and muscle atrophy. Therapy should be based on a multidisciplinary approach, including non-pharmacological therapies (physiotherapy, occupational therapy, psychological therapy), pharmacological treatments (analgesics, steroids, free radical scavengers, calcitonin, bisphosphonates), and invasive interventions (sympathetic nerve blockade, spinal cord stimulators).