சிக்கலான பகுதி வலி நோய் (CRPS) தகவல்

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

• CRPS is a multifactorial condition that requires further study to better understand its pathogenesis, epidemiology, genetic involvement, psychological implications, and treatment options [3].
• The diagnosis of CRPS is a clinical diagnosis based on history and physical examination [9].
• Early recognition and prompt treatment of CRPS are important to minimize permanent loss of function [9].
• Patients with CRPS may still experience permanent impairment and disability despite early recognition and prompt treatment [9].
• The reported incidence of CRPS is influenced by the choice of diagnostic criteria, the study location, and how the fracture is managed [15].
• A more active treatment approach seems to lower the incidence of CRPS-1 [2].
• The incidence of CRPS following isolated cubital tunnel surgery is exceedingly rare, with an overall 1-year incidence rate of approximately 0.33% [10].
• Quantitative sensory testing outcomes indicate altered pain mechanisms in CRPS compared to controls, with a pooled standardized mean difference of -0.41 [5].
• The Hamilton Inventory can be relied upon to assess CRPS symptoms, functional limitations, and psychosocial impacts [4].
• Strong consideration should be given for the use of ketamine in patients presenting with chronic or refractory CRPS [1].
• Prednisolone has potential as a treatment option for CRPS, particularly in resource-limited settings where more specialized interventions may be unavailable [6].
• High-intensity laser therapy (HILT) offers conclusive evidence of pain reduction in CRPS-I, even after the third treatment session [7].
• The methodological quality of non-pharmacological treatment approaches for upper limb CRPS is overall poor [8].

Background & Causes

• CRPS is a multifactorial condition requiring further study to understand its pathogenesis, epidemiology, genetic involvement, psychological implications, and treatment options [3].
• Altered pain mechanisms exist in CRPS compared to controls, with a pooled standardized mean difference of -0.41 in quantitative sensory testing outcomes [5].
• The diagnosis of CRPS is clinical, based on history and physical examination [9].
• Early recognition and prompt treatment are important to minimize permanent loss of function, although patients may still experience permanent impairment and disability [9].
• CRPS following isolated cubital tunnel surgery is exceedingly rare, with an overall 1-year incidence rate of approximately 0.33% [10].
• Female sex is a significant predictor of developing CRPS following treatment of Dupuytren contracture [11].
• Release of more than one digit is a significant predictor of developing CRPS following treatment of Dupuytren contracture [11].
• A large percentage of patients diagnosed with and treated for CRPS type 1 can have full resolution of their symptoms with carpal tunnel release [12].
• Elderly patients have a higher risk of developing CRPS after distal radius fracture surgery [13].
• Females have a higher risk of developing CRPS after distal radius fracture surgery [13].
• Manual laborers have a higher risk of developing CRPS after distal radius fracture surgery [13].
• CRPS-related hand lesions developed in 19.4% of patients following arthroscopic rotator cuff repair [14].
• Preexisting neuropathic disorders are the strongest predictors of CRPS after distal radius fracture [17].
• Traumatic nerve injuries are the strongest predictors of CRPS after distal radius fracture [17].
• Compressive neuropathies are the strongest predictors of CRPS after distal radius fracture [17].
• Cervical radiculopathy is the strongest predictor of CRPS after distal radius fracture [17].
• Patients with scaphoid waist fracture may be at higher risk of CRPS type I [19].
• Women with diabetes mellitus who report severe pain before treatment are at higher risk of CRPS type I following scaphoid waist fracture [19].

Symptoms & Presentation

• CRPS is a multifactorial condition [3].
• Quantitative sensory testing indicates altered pain mechanisms in CRPS compared to controls, with a pooled standardized mean difference of -0.41 [5].
• Pain is a highly debilitating symptom in CRPS-I [7].
• The diagnosis of CRPS is based on history and physical examination [9].
• CRPS should be considered a diagnosis of exclusion [18].
• Glomus tumors should be included in the differential diagnosis for patients with unusual chronic pain or neuropathy [18].

Management

• Quantitative sensory testing outcomes indicate altered pain mechanisms in complex regional pain syndrome compared to controls, with a pooled standardized mean difference of -0.41 [5].
• Early recognition and prompt treatment of CRPS are important to minimize permanent loss of function, though patients may still experience permanent impairment and disability [9].
• The incidence of CRPS following isolated cubital tunnel surgery (CuTS) is approximately 0.33% at 1 year [10].
• Elderly patients have higher risks of developing CRPS after distal radius fracture surgery [13].
• Female patients have higher risks of developing CRPS after distal radius fracture surgery [13].
• Manual laborers have higher risks of developing CRPS after distal radius fracture surgery [13].
• A patient with bilateral Dupuytren’s contractures who developed CRPS-1 after fasciectomy had a positive outcome with no relapse on subsequent collagenase clostridium histolyticum (CCH) injection and manipulation of the other hand [16].

Key Considerations

• In patients with chronic or refractory CRPS, strong consideration should be given for the use of ketamine [1].
• A more active treatment approach appears to lower the incidence of CRPS-1 [2].
• CRPS is a multifactorial condition requiring further study to better understand its pathogenesis, epidemiology, genetic involvement, psychological implications, and treatment options [3].
• Prednisolone is a potential treatment option for CRPS, particularly in resource-limited settings where specialized interventions may be unavailable [6].
• High-intensity laser therapy (HILT) provides conclusive evidence of pain reduction in CRPS-I, even after the third treatment session [7].
• CRPS diagnosis is clinical, based on history and physical examination, with early recognition and prompt treatment important to minimize permanent loss of function [9].
• Patients with CRPS may still experience permanent impairment and disability despite early intervention [9].
• Female sex and the release of more than one digit are significant predictors of developing CRPS following Dupuytren contracture treatment [11].
• A large percentage of patients diagnosed with and treated for CRPS type 1 can achieve full resolution of symptoms with carpal tunnel release [12].
• CRPS-related hand lesions developed in 19.4% of patients following arthroscopic rotator cuff repair (ARCR) [14].
• The reported incidence of CRPS is influenced by the choice of diagnostic criteria, study location, and fracture management [15].
• A patient with bilateral Dupuytren’s contractures developed CRPS-1 after fasciectomy but had a positive outcome with collagenase clostridium histolyticum (CCH) injection and manipulation of the other hand [16].

Key Evidence

• [L1] In patients presenting with chronic or refractory CRPS, strong consideration should be given for the use of ketamine. [1] (10.1177/15589447221131847)
• [L3] A more active treatment approach seems to lower the incidence of CRPS-1. [2] (10.1177/1558944719895782)
• [L4] CRPS is a multifactorial condition that still requires further studying to better understand its pathogenesis, epidemiology, genetic involvement, psychological implications, and treatment options. [3] (10.1007/s40122-021-00279-4)
• [L4] It can be relied upon to assess CRPS symptoms, functional limitations, and psychosocial impacts. [4] (10.1016/j.jht.2025.02.004)
• [L1] The systematic review and meta-analysis of quantitative sensory testing outcomes indicates altered pain mechanisms in complex regional pain syndrome compared to controls, with a pooled standardized mean difference of -0.41. [5] (10.1186/s13018-022-03461-2)
• [L4] The report emphasizes the importance of recognizing CRPS and highlights the potential of prednisolone as a treatment option, particularly in resource-limited settings where more specialized interventions may be unavailable. [6] (10.1186/s12891-024-07333-0)
• [L1] The study results offer conclusive evidence of pain reduction, a highly debilitating symptom in CRPS-I, even after the third HILT treatment session. [7] (10.1016/j.jht.2025.02.009)
• [L1] Methodological quality of non-pharmacological treatment approaches for upper limb CRPS is overall poor. [8] (10.1177/17589983221138610)
• [L2] CRPS following isolated CuTS is exceedingly rare, with an overall 1-year incidence rate of approximately 0.33%. [10] (10.1016/j.jhsg.2026.101028)
• [L3] Female sex and release of more than one digit are significant predictors of developing CRPS. [11] (10.1177/1558944720963915)
• [L3] This study demonstrates that a large percentage of patients diagnosed with and treated for CRPS type 1 can have full resolution of their symptoms with carpal tunnel release. [12] (10.1016/j.jhsa.2024.09.024)
• [L3] The occurrence of CRPS is the result of many factors, with elderly patients, females, and manual laborers having higher risks. [13] (10.1186/s12891-024-07948-3)
• [L3] CRPS-related hand lesions developed in 19.4% of patients following ARCR. [14] (10.5397/cise.2021.00080)
• [L1] The reported incidence of CRPS is influenced by choice of diagnostic criteria, along with the study location and/or how the fracture is managed. [15] (10.1177/1758998320910179)
• [L4] The positive outcome for this woman with Dupuytren's and CRPS-I after CCH injection is encouraging. [16] (10.1016/j.jht.2024.09.002)
• [L3] Preexisting neuropathic disorders, particularly traumatic nerve injuries, compressive neuropathies, and cervical radiculopathy, are the strongest predictors of CRPS after distal radius fracture. [17] (10.1016/j.jhsa.2026.01.004)
• [Case_report] Glomus tumors should be included in the differential diagnosis for patients with unusual chronic pain or neuropathy, and the diagnosis of CRPS should only be a diagnosis of exclusion. [18] (10.1177/1558944719895618)
• [L2] Patients suffering from scaphoid waist fracture may be at a higher risk of CRPS I, especially in women with diabetes mellitus who report severe pain before treatment. [19] (10.1186/s12891-021-04977-0)

References

[1] Pharmacologic Treatments in Upper Extremity Complex Regional Pain Syndrome: A Review and Analysis of Quality of Evidence. HAND. 2022. DOI: 10.1177/15589447221131847

[2] Treatment of Distal Radius Fracture: Does Early Activity Postinjury Lead to a Lower Incidence of Complex Regional Pain Syndrome?. HAND. 2020. DOI: 10.1177/1558944719895782

[3] Complex Regional Pain Syndrome: A Comprehensive Review. Pain and Therapy. 2021. DOI: 10.1007/s40122-021-00279-4

[4] Psychometric evaluation of the Hamilton Inventory to evaluate signs and symptoms in patients with Complex Regional Pain Syndrome (CRPS). Journal of Hand Therapy. 2025. DOI: 10.1016/j.jht.2025.02.004

[5] Pain mechanisms in complex regional pain syndrome: a systematic review and meta-analysis of quantitative sensory testing outcomes. Journal of Orthopaedic Surgery and Research. 2023. DOI: 10.1186/s13018-022-03461-2

[6] Complex regional pain syndrome: diagnostic challenges and favorable response to prednisolone. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-07333-0

[7] Effect of high-intensity laser therapy and mirror therapy on complex regional pain syndrome type I in the hand area: A randomized controlled trial. Journal of Hand Therapy. 2025. DOI: 10.1016/j.jht.2025.02.009

[8] Person-centred management of upper limb complex regional pain syndrome: an integrative review of non-pharmacological treatment. Hand Therapy. 2023. DOI: 10.1177/17589983221138610

[9] Complex Regional Pain Syndrome. 2021.

[10] Incidence and Patient-Level Risk Factors for Complex Regional Pain Syndrome Following Cubital Tunnel Surgery. Journal of Hand Surgery Global Online. 2026. DOI: 10.1016/j.jhsg.2026.101028

[11] Separating Fact From Fiction: A Nationwide Longitudinal Examination of Complex Regional Pain Syndrome Following Treatment of Dupuytren Contracture. HAND. 2020. DOI: 10.1177/1558944720963915

[12] Outcomes of Median Nerve Release in Complex Regional Pain Syndrome Type 1 of the Hand: A Prospective Case Series. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2024.09.024

[13] Dynamic risk factors for complex regional pain syndrome after distal radius fracture surgery: multivariate analysis and prediction. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-07948-3

[14] Clinical outcome in patients with hand lesions associated with complex regional pain syndrome after arthroscopic rotator cuff repair. Clinics in Shoulder and Elbow. 2021. DOI: 10.5397/cise.2021.00080

[15] What is the incidence of complex regional pain syndrome (CRPS) Type I within four months of a wrist fracture in the adult population? A systematic review. Hand Therapy. 2020. DOI: 10.1177/1758998320910179

[16] The case of a woman with bilateral Dupuytren’s contractures who developed CRPS-1 after fasciectomy with no relapse on subsequent collagenase clostridium histolyticum injection and manipulation of the other hand: Considerations for implementing a Budapest criteria checklist and assessing vasomotor instability by measuring differences in skin temperature. Journal of Hand Therapy. 2025. DOI: 10.1016/j.jht.2024.09.002

[17] A Nationwide Propensity Score-Matched Analysis Identifying Preinjury Predictors of Complex Regional Pain Syndrome Following Distal Radius Fracture. The Journal of Hand Surgery. 2026. DOI: 10.1016/j.jhsa.2026.01.004

[18] An Unusual Case of Periosteal Glomus Tumor at the Metacarpal Base Presenting as Type II CRPS: Case Report. HAND. 2020. DOI: 10.1177/1558944719895618

[19] Determinants of complex regional pain syndrome type I in patients with scaphoid waist fracture- a multicenter prospective observational study. BMC Musculoskeletal Disorders. 2022. DOI: 10.1186/s12891-021-04977-0