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Review
. 2023 Dec 27:16:4379-4391.
doi: 10.2147/JPR.S432209. eCollection 2023.

Different Types of Pain in Complex Regional Pain Syndrome Require a Personalized Treatment Strategy

Thomas J P Mangnus  1 , Maaike Dirckx  1 , Frank J P M Huygen  1
Affiliations
Review

Different Types of Pain in Complex Regional Pain Syndrome Require a Personalized Treatment Strategy

Thomas J P Mangnus et al. J Pain Res. .

Abstract

Complex regional pain syndrome (CRPS) is a debilitating painful state of an extremity that can develop after trauma. CRPS is diagnosed by the new International Association for the Study of Pain (IASP) diagnostic criteria for CRPS. The syndrome is characterized by continuing regional pain with abnormal sensory, motor, sudomotor, vasomotor, edema, and/or trophic signs. The clinical presentation of CRPS can be very heterogeneous because CRPS is a multi-mechanism syndrome. Therefore, mechanism-based subgroups have been suggested to personalize treatment for CRPS. Additionally, the presentation of symptom pain may also be able to identify different subgroups of CRPS. In this review, the types of pain recognized by the IASP-nociceptive, neuropathic, and nociplastic pain-will be discussed as possible subgroups for CRPS. Each pain type should be identified in CRPS patients, with a thorough history taking, physical examination, and diagnostic tests or (novel) biomarkers to optimize treatment effectiveness. Over the course of the syndrome, patients with CRPS probably experience more than one distinct pain type. Therefore, pain specialists should be alert to not only adjust their treatment if underlying pathophysiologic mechanisms tend to change but also to personalize the treatment of the associated type of pain in the CRPS patient.

Keywords: CRPS; mixed pain; neuropathic pain; nociceptive pain; nociplastic pain; personalized medicine.

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Conflict of interest statement

Prof. Dr. FJPM Huygen reports personal fees for educational work and grants from ABBOTT, Saluda, and Boston Scientific outside the submitted work. Prof. Dr. Frank JPM Huygen also has patents P121304EP00 and P121304NL00 pending to DRG stimulation for spasticity. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Pain types in Complex Regional Pain Syndrome.
See this image and copyright information in PMC

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