复杂性区域疼痛综合征（CRPS）资料

您正在感受到的症状

复杂性区域疼痛综合征（CRPS）是一种在受伤或手术后疼痛及其他症状持续存在的状况，其表现往往与原始问题不成比例。它可能在骨折或手术后影响您的手部或手臂，其成因是多种因素混合所致，而非单一原因。

主要症状是疼痛。疼痛可能剧烈且令人精疲力竭，并可能扩散至受伤部位之外。疼痛常在夜间或您使用手部后加剧，且可能在您醒来时依然存在。引发疼痛的因素包括对疼痛区域的运动、触摸或压力。休息手部可能使疼痛略有缓解，但疼痛仍可能持续存在。

日常任务可能变得困难。您可能难以握住水壶、转动钥匙、扣纽扣或握笔。写字、做饭和提购物袋都可能感觉比正常情况更费力。有些人发现他们因害怕疼痛而避免使用该手。

CRPS 是根据您的病史和体格检查进行诊断的，而非通过单一的扫描或血液检查。您的医生在确定 CRPS 为解释之前，还会检查其他导致持续疼痛的原因。

早期识别和治疗至关重要。及时治疗可降低永久性运动和功能丧失的风险。尽管如此，即使经过良好的早期护理，有些人仍可能遗留一些永久性功能障碍或残疾。

有些人比其他人更容易发展为 CRPS。女性、老年人以及从事重体力劳动者在腕部骨折手术后面临更高的风险。现有的神经问题，如神经卡压或颈部神经问题，会进一步增加风险。在杜普伊特伦挛缩手术后，女性以及需要松解多根手指的患者更有可能发展为该病。

如果您的疼痛感觉异常或未按预期缓解，请尽早告知您的医生。

实际发生了什么

复杂性区域疼痛综合征（CRPS）并非影像学检查上可见的损伤。您的骨骼或组织损伤可能愈合良好，但您身体处理疼痛的方式已经改变。神经和大脑发送和解读疼痛信号的方式与以往不同，因此，外观正常的手部可能会感到灼烧感、触痛或使用时的疼痛。

可以将其想象成一个过于敏感的烟雾报警器。一丝轻烟就会触发完整的警报，同样地，轻微的触碰或温和的活动也可能引发剧烈疼痛。这就是为什么上述症状源于该疾病本身，而不是因为您做错了什么。

由于疼痛信号本身发生了变化，影像扫描和血液检查对于发现CRPS并不可靠。没有单一的测试可以确诊它。相反，您的医生会通过您的病史和体格检查，并首先排除其他原因。只有在排除其他解释后，才会诊断出CRPS，这就是为什么您可能会被检查诸如球瘤（glomus tumour）之类的情况，这是一种位于指甲下方微小血管中的小增生，可能导致异常的持续性疼痛。

该疾病很复杂，其确切病因仍在研究中。已知的是，多种因素可能共同作用以触发它。在腕部骨折手术后，现有的神经问题，如神经卡压或颈部神经问题，是最强的预测因素。骨折前接受过治疗的情绪困扰，如焦虑或抑郁，大约会使治疗期间发展为CRPS的可能性翻倍。女性、老年人以及从事重体力劳动者也面临更高的风险。

早期发现很重要，因为及时治疗可以降低运动功能永久性丧失的可能性。即便如此，尽管接受了良好的早期护理，有些人仍会留下一些永久性功能障碍。

我们可以采取的措施

您可以自行采取许多措施，通常从活动开始。保持手部和手臂的活动是治疗的核心部分，物理治疗旨在重建手部运动、力量以及使用手部的信心。移动疼痛部位可能感觉奇怪，但温和、持续的活动有助于平息前文所述的过度敏感疼痛信号。更积极的康复方法也能降低受伤后发生复杂性区域疼痛综合征（CRPS）的可能性。请给予这种方法数周而非数天的公平尝试，即使进展缓慢也要坚持下去。有些人还发现镜像疗法有帮助，即一边在镜子中注视未受影响的手，一边活动这只手，您的治疗师可能会使用其他疗法，如激光疗法，以缓解疼痛。

如果自我管理不够，有药物可以帮助。止痛药和抗炎药可以平息发作期并使活动更舒适，这一点很重要，因为手部活动是主要治疗手段。您的医生还可能建议短期服用类固醇片剂，如泼尼松龙，它们能平息炎症并缓解症状，特别是在难以获得专科治疗时。还有直接涂抹于皮肤的选择，如药用乳膏，提供了一种简单的疼痛管理方式。在顽固病例中，有些人会在医院接受氯胺酮输注，它作用于疼痛通路本身。每种方法在副作用和益处持续时间方面都有利弊，因此值得讨论哪种适合您。

如果您的症状严重，且尽管采取了上述步骤仍未缓解，请咨询是否应看专科医生。医生可能会转诊您进行专科评估，对于某些特定的潜在问题，偶尔会考虑进行手术。例如，如果腕部受压的神经是导致症状的原因，松解该神经可使许多人的症状完全消退；已挛缩的僵硬关节可以被轻柔地松解，然后用夹板固定。这些决定会在如前所述排除其他原因之后，根据每个人的具体情况作出。CRPS越早被识别和治疗，避免永久性运动丧失的机会就越大，因此不要拖延寻求帮助。

预期情况

每个人患复杂性区域疼痛综合征（CRPS）后的病程都略有不同，没有固定的时间表可供依赖。对于一些人来说，症状会在数周至数月内逐渐缓解，尤其是在早期开始治疗的情况下。对于另一些人来说，疼痛会持续更长时间，少数人即使在早期得到良好的护理后，仍可能遗留一些永久性的功能障碍或残疾。早期识别和及时治疗能为您提供避免永久性运动丧失的最佳机会，因此切勿拖延寻求帮助。

如果管理得当，预后通常是稳步改善，而非突然痊愈。即使手部活动时会感到轻微疼痛，活动手部也有助于平息前文所述的过度敏感疼痛信号，且进展通常在数周至数月内缓慢积累。某些治疗在过程中能产生实质性差异。镜像疗法和激光疗法可以减轻疼痛，有时在最初几次治疗内即可见效。如果腕部受压的神经是引发症状的原因，松解该神经可使许多人的症状完全消退。已挛缩的僵硬关节可被轻柔地松解，随后进行夹板固定，这通常效果良好。

如果置之不理，情况则不太确定。疼痛可能会持续发作，且随着病程拖延，出现持续性僵硬和功能丧失的风险会增加。在严重且长期存在、对其他任何治疗均无反应的病例中，有时会考虑将手术作为最后手段。这并非常见路径，且仅在尝试其他所有方法后才予以权衡。

诚实地说，CRPS 仍未被完全理解，其病因仍是持续研究的课题。我们所知道的是，保持活动、早期治疗并与您的医疗团队合作，能为您提供最坚实的基础。请将预期设定为渐进式进展，而非快速修复，并在过程中将任何异常情况告知您的医生。

何时就医

如果受伤或手术后疼痛在夜间反复加剧、扩散至受伤部位以外，或感觉远比损伤本身更强烈，请尽早咨询您的全科医生或医生。如果轻微触碰、轻柔活动或温度变化会引发剧烈疼痛，或者手部疼痛严重到让您避免使用它，请寻求帮助。早期识别和治疗复杂性区域疼痛综合征（CRPS）可降低永久性运动功能丧失的风险，因此不要等待症状自行缓解。由于CRPS只有在排除其他原因后才能确诊，因此任何异常的持续性疼痛都应进行检查，而不应归因于原始损伤。

Evidence & references

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].
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].
The reported incidence of CRPS is influenced by the choice of diagnostic criteria, study location, and how the fracture is managed [15].
A more active treatment approach seems to lower the incidence of CRPS-1 following distal radius fracture [2].
CRPS following isolated cubital tunnel surgery is exceedingly rare, with an overall 1-year incidence rate of approximately 0.33% [10].
The Hamilton Inventory can be relied upon to assess CRPS symptoms, functional limitations, and psychosocial impacts [4].

Background & Causes

Pathophysiology and Diagnosis

Quantitative sensory testing outcomes indicate altered pain mechanisms in CRPS compared to controls, with a pooled standardized mean difference of -0.41 [5].
Early recognition and prompt treatment are important to minimize permanent loss of function, though patients may still experience permanent impairment and disability [9].

Risk Factors and Incidence

Female sex and release of more than one digit are significant predictors of developing CRPS following treatment of Dupuytren contracture [11].
Elderly patients, females, and manual laborers have higher risks of developing CRPS after distal radius fracture surgery [13].
Preexisting neuropathic disorders, particularly traumatic nerve injuries, compressive neuropathies, and cervical radiculopathy, are the strongest predictors of CRPS after distal radius fracture [17].
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 [20].
CRPS-related hand lesions developed in 19.4% of patients following arthroscopic rotator cuff repair [14].

Modifiable Factors and Management Implications

Symptoms & Presentation

CRPS is a multifactorial condition [3].
Pain is a highly debilitating symptom in CRPS-I [7].
Patients with CRPS may experience permanent impairment and disability [9].
Glomus tumors should be included in the differential diagnosis for patients with unusual chronic pain or neuropathy [19].
The diagnosis of CRPS should only be a diagnosis of exclusion [19].

Management

Pharmacologic

In patients presenting with chronic or refractory CRPS, strong consideration should be given for the use of ketamine [1].
Prednisolone is a potential treatment option for CRPS, particularly in resource-limited settings where more specialized interventions may be unavailable [6].
Topical application of doxepin may represent a simple option for the management of CRPS [18].

Non-Pharmacologic

A more active treatment approach seems to lower the incidence of CRPS-1 [2].
High-intensity laser therapy and mirror therapy provide conclusive evidence of pain reduction in CRPS-I, even after the third HILT treatment session [7].
The methodological quality of non-pharmacological treatment approaches for upper limb CRPS is overall poor [8].

Operative

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].
The positive outcome for a patient with Dupuytren's and CRPS-I after collagenase clostridium histolyticum injection is encouraging [16].

Assessment and Prognosis

Early recognition and prompt treatment are important to minimize permanent loss of function in CRPS [9].

Key Considerations

Diagnosis and Pathophysiology

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].

Risk Factors and Incidence

Treatment

High-intensity laser therapy and mirror therapy offer conclusive evidence of pain reduction in CRPS-I, even after the third treatment session [7].
A positive outcome was observed for a patient with Dupuytren's contracture and CRPS-I after collagenase clostridium histolyticum injection [16].

Prognosis and Assessment

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)
[L5] This case report suggests that the topical application of doxepin may represent a simple option for the management of CRPS. [18] (10.1016/s0020-1383(01)00054-7)
[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. [19] (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. [20] (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] Topical application of doxepin hydrochloride can reduce the symptoms of complex regional pain syndrome: a case report. Injury. 2002. DOI: 10.1016/s0020-1383(01)00054-7

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

[20] 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