Síndrome de dolor regional complejo

Complex regional pain syndrome (CRPS), formally known as reflex sympathetic dystrophy or Sudeck's syndrome, is a clinical situation with continuous, disproportionate pain occurring weeks or months after trauma or fracture. It is generally located in the distal areas of the limbs. The pain is accompanied by hyperalgesia and allodynia. Other manifestations are oedema, changes in local skin temperature and colouration, altered hair, nail and skin trophism, and changes in sweating. There can be motor manifestations in the more chronic phases, such as muscle weakness, essential tremor, myoclonus and dystonia. Diagnosis is principally clinical and the 2013 IASP criteria are useful. Complementary exploration is of little help, although 3-phase bone scan can confirm the diagnosis. The prognosis is uncertain; the condition generally resolves in the first 12 months. Response to treatment is variable and a multi-disciplinary approach is required with physical and occupational therapy, drugs, and in cases of poor outcome, an interventionist and psychological approach. Glucocorticoids, bisphosphonates and analgesics are effective in the primary stages. The recommended preventative measures include prompt mobilisation after fractures or trauma. Vitamin C also appears to reduce the frequency of CRPS.