Current Concepts in Adult CRPS

C R r s d iag no sis, ep ide m io logy, recov ery, heal th eco no m ics and rare p re5<' ntations C RPS is a pa infu l con d itio n which usually dev elops after trauma to a limb .It is chnracrerbed by li m b_confl n~-d sensory, autonomic, mo to r, skin and bon e cha nges, btu the lead sympto m is pain.Earlier names for th e condi tion are given in app endix A. 111e C Rrs dia gno stic crite ria have recently been up dated ('B ud ape sr Criteria", appen di x B}, becau se ea rlier criteria were nor specific .These new criteria, although widely used have nOI yet been formally ado pted by rhe Int ern ational Associati o n for the Stud y of Pain ( I) .O ver the past 10 years many investigators , scient ists an d clini cians alike have jointl y ach ieved remarkable progr ess in understanding and treating C RPS.These efforts have been e nhanced by th e success of the 'TREN D" conso rt ium led by Prof. J.J. va n Hilren from Leiden and Prof. van der H elm from Delft , who secured in th e early 20 00's over 20 m illio n Eurc in research su ppo rr from th e Durch M inisrry of Econ omic Affairs to study CRPS and related co nd itio ns.As a result of th e first ever.population based Europ ean epidem iolog ical study, we no w unde rstand thai C RPS is mo re commo n (incide nce: 26fJOO.OOO po pulation) than previou sly thought (for com parison, th e incide nce of Mul tiple Sclerosis in th e UK is estima ted at 4 /100.000).It has its pea k in people aged 55-75 years, bur may take a mor e beni gn co urse in this gro up, than in younge r partcnrs (2), C k l'S is associated with m igra ines, osteoporosis and asthma (3).Overall 85% of patie nts will have substan tial pain redu ction within th e flrst 1-2 years afie r d isease o nset.How ever only 30% of partenrs co nsider rhernselves fully recovered even 6 years after d isease o nset, and o nly 40% of people who wor ked before will return 10 their prio r work.C RI'S which has no t im proved ear ly is less likely 10 improve later (4) .A defin it ion of recovery fro m C RPS has not yet bee n achieved.Auto no mic signs usually reduce with rime, even where pain persists (5) .Wirhou l autonomi c signs, a dia gnosis of C Rrs can o ften no t be mad e (Append ix B), so that patients may 'lese' their init ial di agnosis ali: er some years, but cont inue to suffer from pain", It is likely thar we will in th e future define a 'p<>st.C RPS synd rome' for patients who have fulfilled th e Buda pest c rite ria in th e past.Sim ilar as posrherperic I An r"dirr 1,",10'1 u' <Ir mmed 'Omr"'-H"rdrn rrllrrid: but WI" S,rpl/{/tl Onlrh{ tIIldNomu/II Hardor",M, Ih'/l Imtrad rhr 1/"'''' 'Blldtlprll mlrna"is usrd 10 rtf /rrt Ihr /or"IIOII ofl"r rOJMI/!IIl «mft rtJJrr."'CRPS NOS ' (1101 olhrr",I'r ,prdjird) I, ,hr now rtrom", ,,,drd '''1/1fir dUM enm which ;'"d" fufJicirnt Ilumb" of,lg", ("pp",dlx A) In t!lrpmt.but kuk sig'" 011 rXilt'lln"tlon.