Spontaneous onset of Complex Regional Pain Syndrome

Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.
European journal of pain (London, England) (Impact Factor: 2.93). 09/2009; 14(5):510-3. DOI: 10.1016/j.ejpain.2009.08.007
Source: PubMed


Complex Regional Pain Syndrome (CRPS) usually develops after a noxious event, but spontaneous onsets have been described in 3-11% of the cases. The existence of spontaneous-onset CRPS is highly debated and the aim of the present study was therefore to compare the phenotypic characteristics of CRPS patients with a spontaneous onset, with those of patients with a trauma-induced onset. Data of 537 CRPS patients followed up at four departments of anesthesiology were analyzed and comprised 498 (93%) patients with and 39 (7%) patients without a known eliciting event. There where no significant differences between the two groups in gender, or in onset in upper or lower limb or left or right side of the body. Compared to CRPS patients with a trauma-induced onset, spontaneous-onset cases were on average 9 years younger at disease onset and had a 1.4 years longer median disease duration. No significant differences in frequency were found for any of the 34 compared signs and symptoms when the effect of multiple testing was controlled. In conclusion, CRPS may develop both with and without a precipitating noxious event, with both groups exhibiting a largely similar clinical presentation. Spontaneous-onset CRPS patients generally develop the syndrome at a younger age, possibly indicating a susceptibility to develop the condition. The longer disease duration in spontaneous-onset cases may reflect a more gradual disease onset, poorer prognosis, or a delay in diagnosis, possibly as a result of reluctance to make this diagnosis in the absence of a clear initiating event.

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    • "Health professionals have often described physical trauma as antecedent events for CRPS, since the condition was first described (Mitchell 1872). However, the role for psychological stressors as an initiator of CRPS, rather than a consequence of the disorder, has not yet been substantiated (de Rooij et al. 2010). Individuals with CPRS have often been viewed as having a pre-existing susceptibility for exaggerated pain and movement disorders. "
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