Complex Regional Pain Syndrome

Complex Regional Pain Syndrome (CPRS) is a syndrome associated with severe pain in a distal limb with associated peripheral sensory, vasomotor, sudomotor/oedema and motor/trophic changes. Current internationally accepted diagnostic criteria are know as the Budapest Criteria which allow a clinical diagnosis to be made on the basis of a combination of symptoms and signs seen in these four clinical categories. The syndrome has also been called Reflex Sympathetic Dystrophy and Algodystrophy in the past. CRPS involves a complex process where local tissue changes and peripheral & central nervous system changes have been reported in studies but the pathophysiology has not been fully explained. Epidemiological studies report a variance in incidence rates but a higher incidence in women, in the upper limb, after fracture and also a pattern of recovery is seen. Vitamin C prophylaxis has been demonstrated to reduce the incidence of CRPS post wrist fracture in a multicentre study, graded as level 1 evidence. A multidisciplinary approach to management is recommended.