SÍNDROME DOLOROSO REGIONAL COMPLEJO: FISIOPATOLOGÍA, CLÍNICA y MANEJO

Juan Raúl Brin

Submitted August 22, 2024

Published 2026-04-06

Artículos de Investigación

Vol. 19 No. 2 (2006): Revista Médico Científica

COMPLEX REGIONAL PAINSYNDROME: PATHOPHYSIOlOGY, CLlNICAL MANIFESTATIONS, AND MANAGEMENT

Juan Raúl Brin⁺⁻

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Published: 2026-04-06

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Brin JR. COMPLEX REGIONAL PAINSYNDROME: PATHOPHYSIOlOGY, CLlNICAL MANIFESTATIONS, AND MANAGEMENT. rmc [Internet]. 2026 Apr. 6 [cited 2026 Oct. 18];19(2):79-84. Available from: https://revistas.up.ac.pa/index.php/revistamedicocientifica/article/view/5609

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Abstract

Complex regional pain syndrome is currently a poorly understood entity regarding its cause and initiating mechanisms. Symptoms are usually very intense and profoundly affect the quality of life of people who suffer from the disease. This review article will summarize recent concepts in possible physiopathological mechanisms of origin, clinical manifestations, and modes of treatment.

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References

Stanton-Hicks M. Complex regional pain syndrome: manifestations and the role of neurostimulation in its management. J Pain Symptom Manage. 2006 Apr;31(4 Suppl):S20-4.
Ghai B, Dureja GP. Complex regional pain syndrome: a review. J Postgrad Med . 2004 Oct-Dec;50(4):300-7 .
Oaklander AL , Rissmiller JG, Gelman LB, Zheng L,Chang Y, Gott R. Evidence of focal small-fiber axonal degeneration in complex regional pain syndrome-I (reflex sympathetic dystrophy). Pain . 2006 Feb;120(3):235-43 .
Albrecht PJ, Hines S, Eisenberg E, Pud O, Finlay DR, Connolly MK, et al. Pathologic alterations of cutaneous innervation and vasculature in affected limbs from patients with complex regional pain syndrome. Pain 2006;120:244-66.
Parrillo SJ. Complex regional pain syndrome [monografia en internet]. WebMD; c2003-2006 [actualizado viernes 16 de mayo de 2006; citado jueves 14 de diciembre de 2006] . Disponible en: http://www.emedicine.com/emerg/topic497.htm
Gradl G, Gaida S, Finke B, Gierer P, Mittlmeier T, Vollmar B. Exaggeration of tissue trauma induces signs and symptoms of acute CRPS I, however displays distinct differences to experimental CRPS II. Neurosci Lett. 2006 Jul 24;402(3):267-72.
Fish DE. Post-lumbar surgery complex regional pain syndrome. Pain Physician . 2005 Jul;8(3):319-22
Groeneweg JG, Huygen FJ , Heijmans-Antonissen C, Niehof S, Zijlstra FJ. Increased endothelin-1 and diminished nitric oxide levels in blister fluids of patients with intermediate cold type complex regional pain syndrome type 1. BMC Musculoskelet Disord. 2006 Nov 30;7:91.
Schinkel C, Gaertner A, Zaspel J, Zedler S, Faist E, Schuermann M. Inflammatory mediators are altered in the acute phase of posttraumatic complex regional pain syndrome. Clin J Pain. 2006 Mar-Apr;22(3):235-9.
Munnikes RJ, Muis C, Boersma M, Heijmans-Antonissen C, Zijlstra FJ, Huygen FJ. Intermediate stage complex regional pain syndrome type 1 is unrelated to proinflammatory cytokines. Mediators Inflamm. 2005 Dec 14;2005(6):366-72.
. Tan EC, Oyen WJ, Goris RJ. Leukocytes in Complex Regional Pain Syndrome Type 1. Inflammation. 2006 Nov 2; [Epub ahead of print]
Schlereth T, Dittmar JO, Seewald B, Birklein F. Peripheral amplification of sweating - a role for calcitonin gene-related peptide. J Physiol. 2006 Nov 1;576(Pt 3):823-32.
Gross O, Tschernatsch M, Brau ME, Hempelmann G, Birklein F, Kaps M, et al. Increased seroprevalence of parvovirus B 19 IgG in complex regional pain syndrome is not associated with antiendothelial autoimmunity. Eur J Pain. 2006 Mar 16; [Epub ahead of print]
Blaes F, Schmitz K, Tschernatsch M, Kaps M, Krasenbrink I, Hempelmann G, et al. Autoimmune etiology of complex regional pain syndrome. Neurology. 2004 Nov 9;63(9):1734-6.
Pleger B, Ragert P, Schwenkreis P, Forster AF, Wilimzig C, Dinse H et al. Patterns of cortical reorganization parallel impaired tactile discrimination and pain intensity in complex regional pain syndrome. Neuroimage. 2006 Aug 15;32(2):503-10 .
Maihofner C, Neundorfer B, Birklein F, Handwerker HO. Mislocalization of tactile stimulation in patients with complex regional pain syndrome. J Neurol. 2006 Jun;253(6):772-9.
Maihofner C, Handwerker HO, Birklein F. Functional imaging of allodynia in complex regional pain syndrome. Neurology. 2006 Mar 14;66(5):711-7.
Shiraishi S, Kobayashi H, Nihashi T, Kato K, Iwano S, Nishino M, Ishigaki T, Ikeda M, Kato T, Ito K, Kimura T. Cerebral glucose metabolism change in patients with complex regional pain syndrorne: a PET study. Radiat Med. 2006 Jun;24(5):335-44.
Drummond PD, Finch PM. Sensory changes in the forehead of patients with complex regional pain syndrome. Pain. 2006 Jul; 123(1-2):3-5.
Goldberg ME, Domsky R, Scaringe D, Hirsh R, Dotson J, Sharaf I et al. Multi-day low dose ketamine infusion for the treatment of complex regional pain syndrome. Pain Physician. 2005 Apr;8(2): 175-9.
Oteo-Álvaro A, Pérez-Caballer A, Gómez-Castresana F. Tratamiento farmacológico del síndrome doloroso regional complejo de las extremidades como causa de dolor neuropático. Rev Clin Esp. 2004;204(9):486-94.
Vaneker M, Wilder-Smith OH, Schrombges P, Oerlemans HM. Impairments as measured by ISS do not greatly change between one and eight year s after CRPS 1 diagnosis. Eur J Pain. 2006 Oct;10(7):639-44.
Selcuk B, Ersoz M, Inanir M, Kurtaran A, Akyuz M. Sympathetic skin responses in hemiplegic patients with and without complex regional pain syndrome. Neurol India 2006;54:279-282.
Quisel A, Gill JM, Witherell P. Complex regional pain syndrome underdiagnosed. J Fam Pract. 2005 Jun;54(6):524-32.
Wasner G, Schattschneider J, Heckmann K, Maier C, Baron R. Vascular abnormalities in reflex sympathetic dystrophy (CRPS I): mechanisms and diagnostic value. Brain. 2001 Mar;124(Pt 3):587-99.
International Research Foundation for RDS/CRPS [página en Internet]. Tampa: International Research Foundation for RSD / CRPS ; c2003-2006 [actualizado viernes 8 de septiembre de 2006; citado lunes 7 de noviembre de 2006J Clinical practice guidelines - third edition [aprox. 23 páginas]. Disponible en: http://www.rsdfoundation.org/en/en_clinical_practice_guidelines.html
Bruehl S, Chung Oy. Psychological and behavioral aspects of complex regional pain syndrome management. Clin J Pain. 2006 Jun;22(5):430-7.
Singh G, Willen SN, Boswell MV, Janata JW, Chelimsky TC. The value of interdisciplinary pain management in complex regional pain syndrome type I: a prospective outcome study. Pain Physician. 2004 Apr;7(2):203-9.
Boswell MV, Shah RV, Everett CR, Sehgal N, Brown AM, Abdi S et al. Interventional techniques in the management of chronic spinal pain: evidence-based practice guidelines. Pain Physician 2005 Jan;8(1):1-47.
Stojanovic MP, Abdi S. Spinal cord stimulation. Pain Physician. 2002 Apr;5(2):156-66.

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[1] Stanton-Hicks M. Complex regional pain syndrome: manifestations and the role of neurostimulation in its management. J Pain Symptom Manage. 2006 Apr;31(4 Suppl):S20-4.

[2] Ghai B, Dureja GP. Complex regional pain syndrome: a review. J Postgrad Med . 2004 Oct-Dec;50(4):300-7 .

[3] Oaklander AL , Rissmiller JG, Gelman LB, Zheng L,Chang Y, Gott R. Evidence of focal small-fiber axonal degeneration in complex regional pain syndrome-I (reflex sympathetic dystrophy). Pain . 2006 Feb;120(3):235-43 .

[4] Albrecht PJ, Hines S, Eisenberg E, Pud O, Finlay DR, Connolly MK, et al. Pathologic alterations of cutaneous innervation and vasculature in affected limbs from patients with complex regional pain syndrome. Pain 2006;120:244-66.

[5] Parrillo SJ. Complex regional pain syndrome [monografia en internet]. WebMD; c2003-2006 [actualizado viernes 16 de mayo de 2006; citado jueves 14 de diciembre de 2006] . Disponible en: http://www.emedicine.com/emerg/topic497.htm

[6] Gradl G, Gaida S, Finke B, Gierer P, Mittlmeier T, Vollmar B. Exaggeration of tissue trauma induces signs and symptoms of acute CRPS I, however displays distinct differences to experimental CRPS II. Neurosci Lett. 2006 Jul 24;402(3):267-72.

[7] Fish DE. Post-lumbar surgery complex regional pain syndrome. Pain Physician . 2005 Jul;8(3):319-22

[8] Groeneweg JG, Huygen FJ , Heijmans-Antonissen C, Niehof S, Zijlstra FJ. Increased endothelin-1 and diminished nitric oxide levels in blister fluids of patients with intermediate cold type complex regional pain syndrome type 1. BMC Musculoskelet Disord. 2006 Nov 30;7:91.

[9] Schinkel C, Gaertner A, Zaspel J, Zedler S, Faist E, Schuermann M. Inflammatory mediators are altered in the acute phase of posttraumatic complex regional pain syndrome. Clin J Pain. 2006 Mar-Apr;22(3):235-9.

[10] Munnikes RJ, Muis C, Boersma M, Heijmans-Antonissen C, Zijlstra FJ, Huygen FJ. Intermediate stage complex regional pain syndrome type 1 is unrelated to proinflammatory cytokines. Mediators Inflamm. 2005 Dec 14;2005(6):366-72.

[11] . Tan EC, Oyen WJ, Goris RJ. Leukocytes in Complex Regional Pain Syndrome Type 1. Inflammation. 2006 Nov 2; [Epub ahead of print]

[12] Schlereth T, Dittmar JO, Seewald B, Birklein F. Peripheral amplification of sweating - a role for calcitonin gene-related peptide. J Physiol. 2006 Nov 1;576(Pt 3):823-32.

[13] Gross O, Tschernatsch M, Brau ME, Hempelmann G, Birklein F, Kaps M, et al. Increased seroprevalence of parvovirus B 19 IgG in complex regional pain syndrome is not associated with antiendothelial autoimmunity. Eur J Pain. 2006 Mar 16; [Epub ahead of print]

[14] Blaes F, Schmitz K, Tschernatsch M, Kaps M, Krasenbrink I, Hempelmann G, et al. Autoimmune etiology of complex regional pain syndrome. Neurology. 2004 Nov 9;63(9):1734-6.

[15] Pleger B, Ragert P, Schwenkreis P, Forster AF, Wilimzig C, Dinse H et al. Patterns of cortical reorganization parallel impaired tactile discrimination and pain intensity in complex regional pain syndrome. Neuroimage. 2006 Aug 15;32(2):503-10 .

[16] Maihofner C, Neundorfer B, Birklein F, Handwerker HO. Mislocalization of tactile stimulation in patients with complex regional pain syndrome. J Neurol. 2006 Jun;253(6):772-9.

[17] Maihofner C, Handwerker HO, Birklein F. Functional imaging of allodynia in complex regional pain syndrome. Neurology. 2006 Mar 14;66(5):711-7.

[18] Shiraishi S, Kobayashi H, Nihashi T, Kato K, Iwano S, Nishino M, Ishigaki T, Ikeda M, Kato T, Ito K, Kimura T. Cerebral glucose metabolism change in patients with complex regional pain syndrorne: a PET study. Radiat Med. 2006 Jun;24(5):335-44.

[19] Drummond PD, Finch PM. Sensory changes in the forehead of patients with complex regional pain syndrome. Pain. 2006 Jul; 123(1-2):3-5.

[20] Goldberg ME, Domsky R, Scaringe D, Hirsh R, Dotson J, Sharaf I et al. Multi-day low dose ketamine infusion for the treatment of complex regional pain syndrome. Pain Physician. 2005 Apr;8(2): 175-9.

[21] Oteo-Álvaro A, Pérez-Caballer A, Gómez-Castresana F. Tratamiento farmacológico del síndrome doloroso regional complejo de las extremidades como causa de dolor neuropático. Rev Clin Esp. 2004;204(9):486-94.

[22] Vaneker M, Wilder-Smith OH, Schrombges P, Oerlemans HM. Impairments as measured by ISS do not greatly change between one and eight year s after CRPS 1 diagnosis. Eur J Pain. 2006 Oct;10(7):639-44.

[23] Selcuk B, Ersoz M, Inanir M, Kurtaran A, Akyuz M. Sympathetic skin responses in hemiplegic patients with and without complex regional pain syndrome. Neurol India 2006;54:279-282.

[24] Quisel A, Gill JM, Witherell P. Complex regional pain syndrome underdiagnosed. J Fam Pract. 2005 Jun;54(6):524-32.

[25] Wasner G, Schattschneider J, Heckmann K, Maier C, Baron R. Vascular abnormalities in reflex sympathetic dystrophy (CRPS I): mechanisms and diagnostic value. Brain. 2001 Mar;124(Pt 3):587-99.

[26] International Research Foundation for RDS/CRPS [página en Internet]. Tampa: International Research Foundation for RSD / CRPS ; c2003-2006 [actualizado viernes 8 de septiembre de 2006; citado lunes 7 de noviembre de 2006J Clinical practice guidelines - third edition [aprox. 23 páginas]. Disponible en: http://www.rsdfoundation.org/en/en_clinical_practice_guidelines.html

[27] Bruehl S, Chung Oy. Psychological and behavioral aspects of complex regional pain syndrome management. Clin J Pain. 2006 Jun;22(5):430-7.

[28] Singh G, Willen SN, Boswell MV, Janata JW, Chelimsky TC. The value of interdisciplinary pain management in complex regional pain syndrome type I: a prospective outcome study. Pain Physician. 2004 Apr;7(2):203-9.

[29] Boswell MV, Shah RV, Everett CR, Sehgal N, Brown AM, Abdi S et al. Interventional techniques in the management of chronic spinal pain: evidence-based practice guidelines. Pain Physician 2005 Jan;8(1):1-47.

[30] Stojanovic MP, Abdi S. Spinal cord stimulation. Pain Physician. 2002 Apr;5(2):156-66.

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