Review Question - QID 1025

Complex regional pain syndrome is a complex clinical problem for the orthopaedic surgeon. In the acute stage (<3 months), burning or aching pain that cannot be controlled by narcotics is the major feature. Swelling, cool and shiny skin, allodynia and hyperpathia are also clinical features. Crepitus, however, is not a clinical feature.

Hogan et al provide a review of the evaluation and treatment of complex regional pain syndrome. They argue "despite many divergent and often conflicting theories, the cause of the severe pain, alterations in regional blood flow, and edema is unknown. Interventions that have proved successful for treating similar conditions in the arm and hand frequently do not relieve pain similarly in the lower extremity. Common treatment regimens target individual components of this symptom complex, namely, sympathetic or afferent nerve hyperactivity, vasomotor instability, or regional osteoporosis. Despite widespread use of some of these treatments, few controlled clinical trials quantify their effectiveness."

Illustrations A and B shows characteristic features of complex regional pain syndrome of the lower extremity.