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Complex regional pain syndrome type I (CRPS I) is a multifactorial painful disorder with a complex pathogenesis. Both peripheral and central mechanisms are involved. Acute CRPS I is considered to be an exaggerated inflammatory disorder; however, over time, because of altered function of the sympathetic nervous system and maladaptive neuroplasticity, CRPS I evolves into a neurological disorder. This review thoroughly describes the pathophysiological aspects of CRPS I and summarizes the potential therapeutic options. The mechanisms and targets of the treatment are different in the early and late stages of the disease. This current review builds on a previous review by this author group by deepening the role of the peripheral classic and neuronal inflammatory component in the acute stage of this painful disorder. Level of Evidence Not applicable.

1 O.U. of Anesthesia, Intensive Care and Pain Therapy of Sant’Antonio Abate Hospital, Erice Casa Santa, Trapani, Italy. 2 O.U. of Anesthesia, Intensive Care and Pain Therapy of Azienda Ospedaliera Ospedali Riuniti Villa Sofia Cervello, Palermo, Italy. 3 Anesthesiology, Intensive Care and Pain Therapy Department, Catholic University, Medical School, Rome, Italy. 4 Plastic and Reconstructive Surgery Department, University 'Sapienza' of Rome, Italy.

Background Complex regional pain syndrome type I (CRPS I), formerly known as reflex sympathetic dystrophy (RSD), is a chronic painful disorder that usually develops after a minor injury to a limb. This topical review gives a synopsis of CRPS I and discusses the current concepts of our understanding of CRPS I in adults, the diagnosis, and treatment options based on the limited evidence found in medical literature. CRPS I is a multifactorial disorder. Possible pathophysiological mechanisms of CRPS I are classic and neurogenic inflammation, and maladaptive neuroplasticity. At the level of the central nervous system, it has been suggested that an increased input from peripheral nociceptors alters the central processing mechanisms. Methods A literature search was conducted using, as electronic bibliographic database, Medline from 1980 until 2014. Results An early diagnosis and multidisciplinary treatment are necessary to prevent permanent disability. Conclusions The pharmacological treatment of CRPS I is empirical and insufficiently effective. Further research is needed regarding the therapeutic modalities discussed in the guidelines. Physical therapy is widely recommended as a first-line treatment. The efficacy of local anesthetic sympathetic blockade as treatment for CRPS I is questionable.

Objective. The goal of the present study is to verify the efficacy of stellate ganglion block (SGB) in the treatment of facial pain that can be found in different pathological syndromes, and also to examine whether the efficacy is dependent upon when this therapy is administered. Patients. Fifty patients (divided into two randomized groups) with facial pain caused by traumas, iatrogenic issues, herpes zoster, or neurological pathologies participated in this study. Design and Interventions. The first group (N = 25) was treated with SGB produced by 10 administrations of 10 mg of levobupivacaine given every other day, followed by one administration per month for 6 months thereafter. The second group was treated with the drugs tramadol 100 mg/day and gabapentin 1800 mg/day orally for 6 months; during the 7th month they were given SGB therapy using the same methodology as that described for the first group. Results. Before treatment, the mean visual analog scale (VAS) pain score for the first group was 8.89; after the 10th block treatment it was just 0.2, and it remained at that reduced level for the 6th and 12th months. Before treatment, the mean VAS pain score for the second group was 8.83; after the 20th day on medication it was reduced to 4.1, after 6 months it was 5.7 and after 12 months it was 4.9. Conclusions. Our results indicate that patients must be treated with SGB therapy precociously to receive its full benefits.

Die Erkrankung ist bereits seit den 1940er-Jahren bekannt, zunachst aber unter dem Namen „sympathische Reflexdystrophie“. Im Jahr 1993 dann wurde von der International Association for the Study of Pain (IASP) der heute ubliche Begriff des „komplexen regionalen Schmerzsyndroms“ (Complex Regional Pain Syndrome, CRPS) eingefuhrt und in die Formen I und II unterteilt. Bussa et al. legen eine Ubersicht zu den bislang bekannten Daten zum Typ I vor.

Hemodynamic variables were used to evaluate the effectiveness of lumbar chemical sympathectomy in 20 patients with ischemic foot lesions. Early clinical improvement was obtained in 68% of the cases. The two-year cumulative limb salvage rate was 52%. Results indicate that lumbar chemical sympathectomy offers the same benefits as surgical sympathectomy and represents a useful al ternative in patients with advanced ischemic disease of the lower limb, decreas ing the rate and the level of amputations.