Handbook of Pain Syndromes: Biopsychosocial Perspectives

By Andrew R. Block; Edwin F. Kremer et al. | Go to book overview

Chapter 16
Complex Regional Pain Syndromes:
An Interdisciplinary Perspective

Herbert G. Steger
Department of Anesthesiology
University of Kentucky College of Medicine

Stephen Bruehl
R. Norman Harden
Department of Physical Medicine and Rehabilitation
Northwestern University Medical School

Complex regional pain syndrome (CRPS) is characterized by constant, severe, deep, diffuse, burning pain; abnormal pain response; autonomic dysfunction; and difficulty in motor functioning. It typically affects the extremities, but less frequently also affects other areas of the body, including head and breast. CRPS usually develops following surgery, trauma (such as a sprain, fracture, or crush injury), or injury to a peripheral nerve, although it may develop without an initiating event. The condition also has been reported in association with other medical conditions, including myocardial infarction, cerebral vascular accident, traumatic brain injury, neoplastic tumor, cervical and lumbar radiculopathy, and spinal cord injury. Although long thought to affect only adults, CRPS has been found to affect children and adolescents ( Wilder, Berde, Wolohan, Vieyra, & Masek, 1992). The condition develops at variable rates, can spread to other parts of the body, often responds poorly to treatment, and can progress to become a disabling chronic pain syndrome.

CRPS has posed a diagnostic and treatment challenge since its initial description during the American Civil War ( Mitchell, Morehouse, & Keen, 1864). Psychological factors have been presumed to play an integral role in the etiology, maintenance, and outcome of the condition throughout its long history. Recent developments have led to improved understanding of the pathophysiology, diagnosis, treatment, and role of psychological and behavioral factors in CRPS. This chapter reviews these developments and discusses the current interdisciplinary approach to treatment, with an em-

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