Management of patients with complex regional pain syndrome type I

Complex regional pain syndrome type I (CRPS-I)includes different conditions characterized by regional painand sensory, motor, sudomotor, vasomotor, and/or trophicfindings, affecting a peripheral limb usually after a noxiousevent, such as a trauma or surgery. The pathophysiology isstill poorly understood. Limited data are available on the incidenceof CRPS-I, and the disease is underestimated andunder-diagnosed. The disease shows a female preponderanceapproximately 3:1 with a peak age of incidence around the 5thand 6th decade. The available diagnostic criteria for CRPS-Irely on clinical criteria that are unfortunately focused on thesigns and symptoms of the chronic and late disease, whilelittle emphasis is given to the typical imaging (X-rays, bonescintigraphy, MRI) findings of the early phase. Over the lastdecades, several therapies have been proposed but the fewstudies available are often too small to be conclusive andrarely evolved to randomized controlled trials (RCTs). Onthe basis of the results of a few RCTs, only short courses ofhigh bisphosphonate doses appear to provide substantial benefits.The best results are seen in patients in the early phase ofthe disease, often with the persistent remission or completehealing of the conditions. Since the only accredited mechanismof action of bisphosphonates is the suppression of osteoclasticbone resorption, it is likely the initial dramatic boneloss plays a role in the maintenance and evolution of CRPS-I.Short courses of high doses of bisphosphonates should beconsidered the treatment of choice for patients with CRPS-I.