Doan Hoa Ngan, Chang Min Cheol
Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, Republic of Korea.
J Pain Res. 2025 Sep 11;18:4699-4726. doi: 10.2147/JPR.S534655. eCollection 2025.
Complex Regional Pain Syndrome (CRPS) is a chronic pain condition characterized by an exaggerated response to an initial stimulus, accompanied by autonomic, sensory, motor, and sudomotor dysfunctions. Recognized as a systemic disorder, CRPS involves complex interactions among inflammatory, immunologic, neurogenic, genetic, and psychological factors. The primary mechanisms include peripheral and central sensitization, sympathetic nervous system dysregulation, and altered somatosensory processing. However, the exact pathophysiology remains unclear, contributing to ongoing debate about optimal treatment approaches. Management typically involves a multimodal approach. Pharmacologic options such as corticosteroids, ketamine, and bisphosphonates have demonstrated relative safety and efficacy in clinical practice. Moreover, rehabilitation therapies -including cortically directed sensorimotor rehabilitation, range-of-motion or aerobic exercises, exposure therapy, transcutaneous electrical nerve stimulation, and thermal therapy -serve as valuable nonpharmacologic interventions. No consensus currently exists on standardized treatment protocols for CRPS, particularly regarding the choice of non-invasive approaches. In this context, a comprehensive understanding of the underlying pathophysiological mechanisms is essential for guiding appropriate management strategies. This review provides updated insights into the pathophysiological mechanisms of the disease, alongside a synthesis of evidence-based non-invasive treatment, to support mechanism-driven clinical decision-making, potentially improving treatment outcomes.
复杂性区域疼痛综合征（CRPS）是一种慢性疼痛病症，其特征为对初始刺激的反应过度，伴有自主神经、感觉、运动和汗腺功能障碍。CRPS被认为是一种全身性疾病，涉及炎症、免疫、神经、遗传和心理因素之间的复杂相互作用。主要机制包括外周和中枢敏化、交感神经系统失调以及体感处理改变。然而，确切的病理生理学仍不清楚，这导致了关于最佳治疗方法的持续争论。治疗通常采用多模式方法。皮质类固醇、氯胺酮和双膦酸盐等药物选择在临床实践中已显示出相对的安全性和有效性。此外，康复治疗——包括皮质定向感觉运动康复、关节活动度或有氧运动、暴露疗法、经皮电刺激神经疗法和热疗法——是有价值的非药物干预措施。目前对于CRPS的标准化治疗方案尚无共识，尤其是在非侵入性方法的选择方面。在此背景下，全面了解潜在的病理生理机制对于指导适当的管理策略至关重要。本综述提供了对该疾病病理生理机制的最新见解，以及基于证据的非侵入性治疗的综合信息，以支持基于机制的临床决策，可能改善治疗效果。
