ACOEM Guidelines: Complex Regional Pain Syndrome (CRPS)

Objective: This summary of findings related to Complex Regional Pain Syndrome (CRPS) as part of the American College of Occupational and Environmental Medicine’s (ACOEM) updated Chronic Pain guideline seeks to provide clinicians with evidence-based guidance for diagnosing and treating this disorder. Methods: Comprehensive systematic literature reviews were conducted in accordance with the ACOEM Guidelines methodology. Results: Guidance was developed regarding 12 diagnostic methods and 79 treatment methods. Conclusions: First-line treatments for CRPS are education, strengthening exercises, aerobic exercise, fear avoidance belief/kinesiophobia training, NSAIDs, oral glucocorticosteroids, and bisphosphonates. Second-line treatments are mirror therapy, pain exposure therapy, virtual reality (VR), desensitization, antidepressants (TCA, SNRI), gabapentin, and dimethyl sulfoxide (DMSO). Third-line treatments are stellate ganglion blocks and bretylium blocks. Spinal cord stimulator (SCS) implantation is a fourth-line treatment.