Department of Neurology, University Hospital Erlangen, Schwabachanlage, Erlangen, Germany.
Eur J Neurol. 2010 May;17(5):649-60. doi: 10.1111/j.1468-1331.2010.02947.x. Epub 2010 Feb 18.
Complex regional pain syndrome (CRPS), formerly known as Sudeck's dystrophy and causalgia, is a disabling and distressing pain syndrome. We here provide a review based on the current literature concerning the epidemiology, etiology, pathophysiology, diagnosis, and therapy of CRPS. CRPS may develop following fractures, limb trauma or lesions of the peripheral or CNS. The clinical picture comprises a characteristic clinical triad of symptoms including autonomic (disturbances of skin temperature, color, presence of sweating abnormalities), sensory (pain and hyperalgesia), and motor (paresis, tremor, dystonia) disturbances. Diagnosis is mainly based on clinical signs. Several pathophysiological concepts have been proposed to explain the complex symptoms of CRPS: (i) facilitated neurogenic inflammation; (ii) pathological sympatho-afferent coupling; and (iii) neuroplastic changes within the CNS. Furthermore, there is accumulating evidence that genetic factors may predispose for CRPS. Therapy is based on a multidisciplinary approach. Non-pharmacological approaches include physiotherapy and occupational therapy. Pharmacotherapy is based on individual symptoms and includes steroids, free radical scavengers, treatment of neuropathic pain, and finally agents interfering with bone metabolism (calcitonin, biphosphonates). Invasive therapeutic concepts include implantation of spinal cord stimulators. This review covers new aspects of pathophysiology and therapy of CRPS.
复杂性区域疼痛综合征（CRPS），以前称为 Sudeck 营养不良和反射性交感神经营养不良，是一种使人丧失能力和痛苦的疼痛综合征。我们在此根据有关 CRPS 的流行病学、病因、病理生理学、诊断和治疗的当前文献提供了一篇综述。CRPS 可能在骨折、肢体创伤或周围或中枢神经系统的损伤后发生。临床表现包括自主神经（皮肤温度、颜色、出汗异常）、感觉（疼痛和痛觉过敏）和运动（瘫痪、震颤、肌张力障碍）障碍的特征性临床三联征。诊断主要基于临床体征。已经提出了几种病理生理概念来解释 CRPS 的复杂症状：（i）促进的神经源性炎症；（ii）病理性交感传入耦合；和（iii）中枢神经系统内的神经可塑性变化。此外，越来越多的证据表明遗传因素可能使 CRPS 易于发生。治疗基于多学科方法。非药物治疗包括物理治疗和职业治疗。药物治疗基于个体症状，包括类固醇、自由基清除剂、治疗神经病理性疼痛，以及最后干扰骨代谢的药物（降钙素、双膦酸盐）。有创治疗概念包括脊髓刺激器的植入。这篇综述涵盖了 CRPS 的病理生理学和治疗的新方面。
