Zespół bólowy kompleksowy – Rokowania, prognozy i postęp choroby

Zespół bólowy kompleksowy
Rokowania, prognozy i postęp choroby

Zespół bólowy kompleksowy (CRPS) charakteryzuje się zróżnicowanym przebiegiem klinicznym, z około 85% pacjentów doświadczających zmniejszenia bólu i objawów w ciągu pierwszych 2 lat od wystąpienia choroby. Jednakże ból i dysfunkcja motoryczna utrzymują się u 51-89% pacjentów po 12 miesiącach, co wskazuje na przewlekły charakter schorzenia u znacznej części chorych. Czynniki prognostyczne o najsilniejszym związku z gorszym rokowaniem to zaburzenia czuciowe oraz niska temperatura skóry (tzw. „zimna” postać CRPS), a także zajęcie kończyny górnej. Nasilający się dystres psychologiczny oraz unikanie ruchu bolesnej kończyny sprzyjają cięższemu przebiegowi i dekondycjonowaniu, co pogarsza rokowanie. Wczesne, agresywne leczenie w ciągu pierwszych 3 miesięcy od wystąpienia objawów jest kluczowe dla poprawy rokowania i zmniejszenia ryzyka przewlekłego bólu oraz nieodwracalnych zmian w tkankach.

Prognoza zespołu bólowego kompleksowego

Zespół bólowy kompleksowy (CRPS – Complex Regional Pain Syndrome) charakteryzuje się zróżnicowanymi wynikami leczenia – od całkowitego ustąpienia objawów po przewlekły ból utrzymujący się przez wiele lat. Dane dotyczące prognozy wskazują, że około 85% pacjentów doświadcza zmniejszenia bólu i niektórych objawów w ciągu pierwszych 2 lat od wystąpienia choroby.¹ Jednak obecnie nie ma możliwości przewidzenia, u których pacjentów nastąpi poprawa i kiedy to może nastąpić.

Badania retrospektywne dokumentują różnorodne wyniki u pacjentów z CRPS. Jedno z badań sugeruje, że CRPS zwykle ustępuje samoistnie bez leczenia, choć nie określono dokładnych ram czasowych. Badanie populacyjne w Stanach Zjednoczonych wykazało ustąpienie objawów u 74% pacjentów.² Podobnie, w badaniu przeprowadzonym w Minnesocie, 74% pacjentów doświadczyło całkowitego ustąpienia objawów.³

Z drugiej strony, szereg badań wskazuje, że ból i dysfunkcja motoryczna są najbardziej dominującymi długoterminowymi cechami CRPS, utrzymującymi się u 51-89% pacjentów po 12 miesiącach od wystąpienia.⁴ Dane te są zgodne z wcześniejszymi przeglądami sprzed dekady, które również wskazywały na ból i dysfunkcję motoryczną jako najbardziej uporczywe i upośledzające cechy długotrwałego CRPS.⁵

Czynniki prognostyczne w zespole bólowym kompleksowym

Identyfikacja czynników prognostycznych w CRPS jest kluczowa dla przewidywania przebiegu choroby. Systematyczne przeglądy zidentyfikowały 28 potencjalnych czynników prognostycznych, jednak dowody dotyczące większości z nich są ograniczone.⁶ Zaburzenia czuciowe i niska temperatura skóry (tzw. „zimna” postać CRPS) są parametrami najsilniej związanymi z gorszą prognozą.⁷⁸

Gorsze wyniki są również związane z zajęciem kończyny górnej.⁹¹⁰ Nasilający się dystres psychologiczny w połączeniu z urazem fizycznym wykazano jako czynnik zwiększający ryzyko CRPS i nasilenie objawów CRPS w 6- i 12-miesięcznych interwałach.¹¹

Nieużywanie bolesnej kończyny, jako zachowanie wyuczone w celu unikania bólu, jest również czynnikiem predykcyjnym ciężkich objawów CRPS, w tym bólu stawów podczas ruchu, hiperalgezji, zmian we wzroście włosów i zmian temperatury skóry.¹² Brak aktywności kończyny po urazie, czy to z powodu bólu, rekonwalescencji, czy dystresu psychologicznego, może prowadzić do dekondycjonowania.¹³ Ta sekwencja zmian fizjologicznych nie tylko intensyfikuje objawy CRPS, ale jest również związana z mniej korzystnym rokowaniem.¹⁴

Wpływ wczesnej interwencji na prognozę

Wczesne i agresywne leczenie znacząco poprawia rokowanie w CRPS, zmniejszając ryzyko przewlekłego, upośledzającego bólu.¹⁵ Idealny czas na rozpoczęcie leczenia to pierwsze 3 miesiące od wystąpienia objawów, jednak w wielu przypadkach pacjenci nie zostają zdiagnozowani w tym czasie.¹⁶

Jeśli leczenie jest opóźnione, zaburzenie może szybko rozprzestrzenić się na całą kończynę, a zmiany w kościach, nerwach i mięśniach mogą stać się nieodwracalne.¹⁷¹⁸ W przypadku długotrwałego nieleczonego CRPS, kończyna może doświadczyć degradacji kości, uszkodzenia nerwów oraz uszkodzeń strukturalnych mięśni i ścięgien.¹⁹

Jeśli CRPS zostanie zdiagnozowany wcześnie i leczenie rozpocznie się jak najszybciej, istnieje szansa, że zaburzenie może wejść w remisję. Przy odpowiednim leczeniu pacjent może doświadczyć nawet 5 lat lub więcej remisji, zanim skutki CRPS powrócą.²⁰

Długoterminowy wpływ na funkcje kończyn i status zawodowy

Dane z systematycznych przeglądów dostarczają pierwszych ilościowych danych dotyczących utraty funkcji motorycznych i długoterminowych kompromisów w zakresie statusu zawodowego związanych z epizodem CRPS.²¹ Wyniki wskazują, że długoterminowy wpływ jednego epizodu CRPS na funkcję kończyn i status zawodowy jest stosunkowo wysoki.²²

Ogólne wyniki pokazują, że około 1/3 pacjentów nie jest w stanie wrócić do pracy w długoterminowej obserwacji z powodu CRPS, podczas gdy dalsza część pacjentów doświadcza pewnych kompromisów w statusie zawodowym.²³ Holenderskie badanie wykazało ciężką progresję objawów u 16% pacjentów, a 54% pacjentów pozostało w stanie stabilnym. Spośród 54 ze 102 pacjentów, którzy pracowali przed diagnozą CRPS, 41% wróciło do pracy bez ograniczeń, 28% wróciło do pracy z pewnymi ograniczeniami, a 31% nie było w stanie wrócić do pracy.²⁴

Czynniki psychospołeczne a prognoza

Czynniki psychospołeczne odgrywają istotną rolę w rokowaniu CRPS, szczególnie w przypadkach opornych na terapię. Badania wykazały, że złe wyniki amputacji w długotrwałym, opornym na terapię CRPS-1 są związane z czynnikami psychologicznymi.²⁵

Zidentyfikowano cztery główne czynniki psychologiczne związane z gorszymi wynikami:

Słabe wsparcie społeczne wiązało się z mniejszą redukcją najgorszego bólu w ostatnim tygodniu²⁶
Niska odporność psychiczna była związana z mniej istotną poprawą w mobilności²⁷
Zaburzenia psychiatryczne lub historia zaburzeń psychiatrycznych wiązały się z zgłaszanym i obserwowanym nawrotem objawów w innym miejscu²⁸

Warto zauważyć, że dane nie potwierdzają zakładanej roli czynników psychologicznych lub zaburzeń psychiatrycznych w etiologii, rozwoju i utrzymywaniu się CRPS-I. Potwierdzają natomiast rolę czynników psychologicznych w rehabilitacji.²⁹

Nawroty i remisje

Niektóre przypadki CRPS mogą ustąpić samoistnie, podczas gdy inne mogą mieć charakter przewlekły lub nawracająco-remisyjny.³⁰ Po wejściu CRPS w remisję, prawdopodobieństwo jego ponownego wystąpienia jest znaczne. Ważne jest podejmowanie środków ostrożności i natychmiastowe leczenie po każdym urazie.³¹

Kluczem do dobrej prognozy w CRPS jest kontynuowanie leczenia i niepoddawanie się. Mimo że pokusa poddania się nadzwyczajnemu bólowi i pozwolenia dotkniętym kończynom na zanik jest silna, droga do aktywnego stylu życia z upośledzającym bólem CRPS została już wytyczona.³²

Ograniczenia obecnych badań prognostycznych

Dowody dotyczące czynników prognostycznych CRPS są ograniczone, co uniemożliwia wyciągnięcie jednoznacznych wniosków.³³ Nie znaleziono badania opracowującego lub walidującego instrument prognostyczny do identyfikacji pacjentów z gorszym rokowaniem CRPS-1.³⁴

Obecne dowody są słabe, a spójność znaleziono tylko dla negatywnych cech predykcyjnych, takich jak zaburzenia czuciowe i niska temperatura skóry.³⁵ Zidentyfikowane czynniki ryzyka nie są też wystarczająco czułe.³⁶

Długoterminowy wpływ CRPS na funkcje kończyn i status zawodowy jest znacznie większy niż wcześniej opisywano, co ilustruje, jak szerszy wpływ ekonomiczny CRPS na zdrowie nie jest jeszcze w pełni zrozumiany.³⁷

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Materiały źródłowe

#1
https://www.nhs.uk/conditions/complex-regional-pain-syndrome/treatment/
There’s no known cure for complex regional pain syndrome (CRPS), but a combination of physical treatments, medicine and psychological support can help manage the symptoms. […] It’s estimated around 85% of people with CRPS slowly experience a reduction in their pain and some of their symptoms in the first 2 years. […] There’s currently no way to predict who will improve and when this may happen.
#2 Complex Regional Pain Syndrome | AAFP
https://www.aafp.org/pubs/afp/issues/2021/0700/p49.html
Retrospective chart reviews document a variety of outcomes in patients with CRPS, from full resolution of symptoms to persistent, chronic pain that lasts for years. […] One study suggests that CRPS usually resolves spontaneously without treatment, although the time frame is not specified. […] Two studies showed that only a minority of patients develop chronic and severely disabling symptoms. A Dutch study showed severe progression of symptoms in 16% of patients, and 54% of patients were stable. Of the 54 out of 102 patients who were working before the CRPS diagnosis, 41% returned to work without restrictions, 28% returned to work with some restrictions, and 31% were not able to return to work. […] A population-based study in the United States showed resolution of symptoms in 74% of patients.
#3 Complex regional pain syndrome – Wikipedia
https://en.wikipedia.org/wiki/Complex_regional_pain_syndrome
Some cases of CRPS may resolve spontaneously, with 74% of patients in a Minnesota study experiencing complete symptom resolution, while others may have chronic or relapsing-and-remitting disease. […] Once one is diagnosed with CRPS, should it go into remission, the likelihood of it resurfacing after remission is considerable. Taking precautions and seeking immediate treatment upon any injury is important.
#4 Complex regional pain syndrome what is the outcome? â a systematic review of the course and impact of CRPS at 12 months from symptom onset and beyond
https://pmc.ncbi.nlm.nih.gov/articles/PMC9324966/
Twentytwo included studies suggest that pain and motor dysfunction are the most dominant longterm features of CRPS, persisting for 51%89% of patients at 12 months. […] Results provide firsttime quantitative data including specific evidence about losses to motor function and longterm compromises to work status. […] Results demonstrate that the ongoing impact of one episode of CRPS on limb function and work status is relatively high. […] This review provides firsttime clarity in relation to outcomes of limb function and work status associated with an episode of CRPS, beyond 12 months from onset. […] Results demonstrate that the longterm impact of an episode of CRPS on these outcomes is much larger than previously described, and thus also illustrates how the wider health economic impact of CRPS is not yet fully understood.
#5 Complex regional pain syndrome what is the outcome? â a systematic review of the course and impact of CRPS at 12 months from symptom onset and beyond
https://pmc.ncbi.nlm.nih.gov/articles/PMC9324966/
Overall results show roughly 1/3 of patients are unable to RTW at longterm FU because of CRPS, while a further proportion of patients experience some work status compromise. […] Results from this review concur with review 10 years ago indicating pain and motor dysfunction are the most persistent disabling features of ongoing CRPS. […] We now also report firsttime quantitative data specific evidence about losses to motor function, longterm compromises to work status.
#6 Journal of Rehabilitation Medicine – Prognostic factors in complex regional pain syndrome 1: A systematic review – HTML
https://www.medicaljournals.se/jrm/content/html/10.2340/16501977-1103
The aim of this systematic review was to merge and summarize the current evidence about prognostic factors relevant to the course of complex regional pain syndrome 1. […] A total of 28 prognostic factors was identified. Sensory disturbances and cold skin temperature appear to represent parameters associated with poor prognosis in complex regional pain syndrome 1. […] Evidence about prognostic factors for complex regional pain syndrome 1 is scarce, which prevents firm conclusions being drawn. […] Clinical manifestations, such as the presence of cold skin temperature and sensory disturbances, seem to represent parameters associated with a poor prognosis in CRPS 1. […] We found no study developing or validating a prognostic instrument to identify patients with poor CRPS 1 prognosis. […] The current evidence is weak, and consistency was found only for negative predictive features, such as sensory disturbances and cold skin temperature.
#7 Journal of Rehabilitation Medicine – Prognostic factors in complex regional pain syndrome 1: A systematic review – HTML
https://www.medicaljournals.se/jrm/content/html/10.2340/16501977-1103
The aim of this systematic review was to merge and summarize the current evidence about prognostic factors relevant to the course of complex regional pain syndrome 1. […] A total of 28 prognostic factors was identified. Sensory disturbances and cold skin temperature appear to represent parameters associated with poor prognosis in complex regional pain syndrome 1. […] Evidence about prognostic factors for complex regional pain syndrome 1 is scarce, which prevents firm conclusions being drawn. […] Clinical manifestations, such as the presence of cold skin temperature and sensory disturbances, seem to represent parameters associated with a poor prognosis in CRPS 1. […] We found no study developing or validating a prognostic instrument to identify patients with poor CRPS 1 prognosis. […] The current evidence is weak, and consistency was found only for negative predictive features, such as sensory disturbances and cold skin temperature.
#8 Complex regional pain syndrome – Wikipedia
https://en.wikipedia.org/wiki/Complex_regional_pain_syndrome
The prognosis of CRPS is improved with early and aggressive treatment, with the risk of chronic, debilitating pain being reduced with the early treatment. […] If treatment is delayed, however, the disorder can quickly spread to the entire limb, and changes in bone, nerve, and muscle may become irreversible. […] The prognosis worsens with the chronic „cold” form of CRPS and CRPS affecting the upper extremities. […] Inactivity of the limb following an injury, whether due to pain or recovery or, in some instances, psychological distress after the injury, can lead to deconditioning. […] The absence of movement contributes to muscle atrophy, swelling, joint stiffness and pain, and reduced circulation, among other processes. […] This sequence of physiological changes not only intensifies the symptoms of CRPS but is also associated with a less favorable prognosis.
#9 Complex Regional Pain Syndrome | AAFP
https://www.aafp.org/pubs/afp/issues/2021/0700/p49.html
Worse outcomes are associated with upper extremity limb involvement and cold CRPS symptoms. […] Worsening psychological distress in conjunction with physical injury has been demonstrated to increase the risk of CRPS and the severity of CRPS symptoms at six- and 12-month intervals. […] Disuse of the painful extremity, a learned behavior for avoiding pain, is also predictive of severe CRPS symptoms, including joint pain with movement, hyperalgesia, hair growth changes, and changes in skin temperature.
#10 Complex regional pain syndrome – Wikipedia
https://en.wikipedia.org/wiki/Complex_regional_pain_syndrome
The prognosis of CRPS is improved with early and aggressive treatment, with the risk of chronic, debilitating pain being reduced with the early treatment. […] If treatment is delayed, however, the disorder can quickly spread to the entire limb, and changes in bone, nerve, and muscle may become irreversible. […] The prognosis worsens with the chronic „cold” form of CRPS and CRPS affecting the upper extremities. […] Inactivity of the limb following an injury, whether due to pain or recovery or, in some instances, psychological distress after the injury, can lead to deconditioning. […] The absence of movement contributes to muscle atrophy, swelling, joint stiffness and pain, and reduced circulation, among other processes. […] This sequence of physiological changes not only intensifies the symptoms of CRPS but is also associated with a less favorable prognosis.
#11 Complex Regional Pain Syndrome | AAFP
https://www.aafp.org/pubs/afp/issues/2021/0700/p49.html
Worse outcomes are associated with upper extremity limb involvement and cold CRPS symptoms. […] Worsening psychological distress in conjunction with physical injury has been demonstrated to increase the risk of CRPS and the severity of CRPS symptoms at six- and 12-month intervals. […] Disuse of the painful extremity, a learned behavior for avoiding pain, is also predictive of severe CRPS symptoms, including joint pain with movement, hyperalgesia, hair growth changes, and changes in skin temperature.
#12 Complex Regional Pain Syndrome | AAFP
https://www.aafp.org/pubs/afp/issues/2021/0700/p49.html
Worse outcomes are associated with upper extremity limb involvement and cold CRPS symptoms. […] Worsening psychological distress in conjunction with physical injury has been demonstrated to increase the risk of CRPS and the severity of CRPS symptoms at six- and 12-month intervals. […] Disuse of the painful extremity, a learned behavior for avoiding pain, is also predictive of severe CRPS symptoms, including joint pain with movement, hyperalgesia, hair growth changes, and changes in skin temperature.
#13 Complex regional pain syndrome – Wikipedia
https://en.wikipedia.org/wiki/Complex_regional_pain_syndrome
The prognosis of CRPS is improved with early and aggressive treatment, with the risk of chronic, debilitating pain being reduced with the early treatment. […] If treatment is delayed, however, the disorder can quickly spread to the entire limb, and changes in bone, nerve, and muscle may become irreversible. […] The prognosis worsens with the chronic „cold” form of CRPS and CRPS affecting the upper extremities. […] Inactivity of the limb following an injury, whether due to pain or recovery or, in some instances, psychological distress after the injury, can lead to deconditioning. […] The absence of movement contributes to muscle atrophy, swelling, joint stiffness and pain, and reduced circulation, among other processes. […] This sequence of physiological changes not only intensifies the symptoms of CRPS but is also associated with a less favorable prognosis.
#14 Complex regional pain syndrome – Wikipedia
https://en.wikipedia.org/wiki/Complex_regional_pain_syndrome
The prognosis of CRPS is improved with early and aggressive treatment, with the risk of chronic, debilitating pain being reduced with the early treatment. […] If treatment is delayed, however, the disorder can quickly spread to the entire limb, and changes in bone, nerve, and muscle may become irreversible. […] The prognosis worsens with the chronic „cold” form of CRPS and CRPS affecting the upper extremities. […] Inactivity of the limb following an injury, whether due to pain or recovery or, in some instances, psychological distress after the injury, can lead to deconditioning. […] The absence of movement contributes to muscle atrophy, swelling, joint stiffness and pain, and reduced circulation, among other processes. […] This sequence of physiological changes not only intensifies the symptoms of CRPS but is also associated with a less favorable prognosis.
#15 Complex regional pain syndrome – Wikipedia
https://en.wikipedia.org/wiki/Complex_regional_pain_syndrome
The prognosis of CRPS is improved with early and aggressive treatment, with the risk of chronic, debilitating pain being reduced with the early treatment. […] If treatment is delayed, however, the disorder can quickly spread to the entire limb, and changes in bone, nerve, and muscle may become irreversible. […] The prognosis worsens with the chronic „cold” form of CRPS and CRPS affecting the upper extremities. […] Inactivity of the limb following an injury, whether due to pain or recovery or, in some instances, psychological distress after the injury, can lead to deconditioning. […] The absence of movement contributes to muscle atrophy, swelling, joint stiffness and pain, and reduced circulation, among other processes. […] This sequence of physiological changes not only intensifies the symptoms of CRPS but is also associated with a less favorable prognosis.
#16 Prognosis with CRPS Cases
https://www.crpslawsuit.com/prognosis/
If complex regional pain syndrome (CRPS) is identified and treated early, the chances of a positive prognosis for the patient increase significantly. The ideal time for treatment to begin is within the first 3 months; in many cases, however, patients have not yet been diagnosed within this timeframe. The longer treatment is delayed, the worse the outcome will likely be. […] If the disorder is allowed to progress untreated for too long, the consequences may be irreversible. CRPS can quickly spread from an extremity to negatively affect the entire limb. If this happens, the limb may experience bone degradation and nerve damage over time, as well as structural damage to muscles and tendons. […] If CRPS is diagnosed early and treatment begins as soon as possible, however, there is a chance that the disorder may go into remission. With treatment, a sufferer may experience as many as 5 years of remission or more before the effects of CRPS return. Sadly, there is no cure for RSD or causalgia, and while the symptoms may be pushed back for a time, they do return. […] The key to having a good prognosis with CRPS is to continue treatment and not give up. The temptation to give in to extraordinary pain and let the affected limbs simply waste away is strong, but the way to living an active lifestyle with the debilitating pain of CRPS has already been paved.
#17 Complex regional pain syndrome – Wikipedia
https://en.wikipedia.org/wiki/Complex_regional_pain_syndrome
The prognosis of CRPS is improved with early and aggressive treatment, with the risk of chronic, debilitating pain being reduced with the early treatment. […] If treatment is delayed, however, the disorder can quickly spread to the entire limb, and changes in bone, nerve, and muscle may become irreversible. […] The prognosis worsens with the chronic „cold” form of CRPS and CRPS affecting the upper extremities. […] Inactivity of the limb following an injury, whether due to pain or recovery or, in some instances, psychological distress after the injury, can lead to deconditioning. […] The absence of movement contributes to muscle atrophy, swelling, joint stiffness and pain, and reduced circulation, among other processes. […] This sequence of physiological changes not only intensifies the symptoms of CRPS but is also associated with a less favorable prognosis.
#18 Prognosis with CRPS Cases
https://www.crpslawsuit.com/prognosis/
If complex regional pain syndrome (CRPS) is identified and treated early, the chances of a positive prognosis for the patient increase significantly. The ideal time for treatment to begin is within the first 3 months; in many cases, however, patients have not yet been diagnosed within this timeframe. The longer treatment is delayed, the worse the outcome will likely be. […] If the disorder is allowed to progress untreated for too long, the consequences may be irreversible. CRPS can quickly spread from an extremity to negatively affect the entire limb. If this happens, the limb may experience bone degradation and nerve damage over time, as well as structural damage to muscles and tendons. […] If CRPS is diagnosed early and treatment begins as soon as possible, however, there is a chance that the disorder may go into remission. With treatment, a sufferer may experience as many as 5 years of remission or more before the effects of CRPS return. Sadly, there is no cure for RSD or causalgia, and while the symptoms may be pushed back for a time, they do return. […] The key to having a good prognosis with CRPS is to continue treatment and not give up. The temptation to give in to extraordinary pain and let the affected limbs simply waste away is strong, but the way to living an active lifestyle with the debilitating pain of CRPS has already been paved.
#19 Prognosis with CRPS Cases
https://www.crpslawsuit.com/prognosis/
If complex regional pain syndrome (CRPS) is identified and treated early, the chances of a positive prognosis for the patient increase significantly. The ideal time for treatment to begin is within the first 3 months; in many cases, however, patients have not yet been diagnosed within this timeframe. The longer treatment is delayed, the worse the outcome will likely be. […] If the disorder is allowed to progress untreated for too long, the consequences may be irreversible. CRPS can quickly spread from an extremity to negatively affect the entire limb. If this happens, the limb may experience bone degradation and nerve damage over time, as well as structural damage to muscles and tendons. […] If CRPS is diagnosed early and treatment begins as soon as possible, however, there is a chance that the disorder may go into remission. With treatment, a sufferer may experience as many as 5 years of remission or more before the effects of CRPS return. Sadly, there is no cure for RSD or causalgia, and while the symptoms may be pushed back for a time, they do return. […] The key to having a good prognosis with CRPS is to continue treatment and not give up. The temptation to give in to extraordinary pain and let the affected limbs simply waste away is strong, but the way to living an active lifestyle with the debilitating pain of CRPS has already been paved.
#20 Prognosis with CRPS Cases
https://www.crpslawsuit.com/prognosis/
If complex regional pain syndrome (CRPS) is identified and treated early, the chances of a positive prognosis for the patient increase significantly. The ideal time for treatment to begin is within the first 3 months; in many cases, however, patients have not yet been diagnosed within this timeframe. The longer treatment is delayed, the worse the outcome will likely be. […] If the disorder is allowed to progress untreated for too long, the consequences may be irreversible. CRPS can quickly spread from an extremity to negatively affect the entire limb. If this happens, the limb may experience bone degradation and nerve damage over time, as well as structural damage to muscles and tendons. […] If CRPS is diagnosed early and treatment begins as soon as possible, however, there is a chance that the disorder may go into remission. With treatment, a sufferer may experience as many as 5 years of remission or more before the effects of CRPS return. Sadly, there is no cure for RSD or causalgia, and while the symptoms may be pushed back for a time, they do return. […] The key to having a good prognosis with CRPS is to continue treatment and not give up. The temptation to give in to extraordinary pain and let the affected limbs simply waste away is strong, but the way to living an active lifestyle with the debilitating pain of CRPS has already been paved.
#21 Complex regional pain syndrome what is the outcome? â a systematic review of the course and impact of CRPS at 12 months from symptom onset and beyond
https://pmc.ncbi.nlm.nih.gov/articles/PMC9324966/
Twentytwo included studies suggest that pain and motor dysfunction are the most dominant longterm features of CRPS, persisting for 51%89% of patients at 12 months. […] Results provide firsttime quantitative data including specific evidence about losses to motor function and longterm compromises to work status. […] Results demonstrate that the ongoing impact of one episode of CRPS on limb function and work status is relatively high. […] This review provides firsttime clarity in relation to outcomes of limb function and work status associated with an episode of CRPS, beyond 12 months from onset. […] Results demonstrate that the longterm impact of an episode of CRPS on these outcomes is much larger than previously described, and thus also illustrates how the wider health economic impact of CRPS is not yet fully understood.
#22 Complex regional pain syndrome what is the outcome? â a systematic review of the course and impact of CRPS at 12 months from symptom onset and beyond
https://pmc.ncbi.nlm.nih.gov/articles/PMC9324966/
Twentytwo included studies suggest that pain and motor dysfunction are the most dominant longterm features of CRPS, persisting for 51%89% of patients at 12 months. […] Results provide firsttime quantitative data including specific evidence about losses to motor function and longterm compromises to work status. […] Results demonstrate that the ongoing impact of one episode of CRPS on limb function and work status is relatively high. […] This review provides firsttime clarity in relation to outcomes of limb function and work status associated with an episode of CRPS, beyond 12 months from onset. […] Results demonstrate that the longterm impact of an episode of CRPS on these outcomes is much larger than previously described, and thus also illustrates how the wider health economic impact of CRPS is not yet fully understood.
#23 Complex regional pain syndrome what is the outcome? â a systematic review of the course and impact of CRPS at 12 months from symptom onset and beyond
https://pmc.ncbi.nlm.nih.gov/articles/PMC9324966/
Overall results show roughly 1/3 of patients are unable to RTW at longterm FU because of CRPS, while a further proportion of patients experience some work status compromise. […] Results from this review concur with review 10 years ago indicating pain and motor dysfunction are the most persistent disabling features of ongoing CRPS. […] We now also report firsttime quantitative data specific evidence about losses to motor function, longterm compromises to work status.
#24 Complex Regional Pain Syndrome | AAFP
https://www.aafp.org/pubs/afp/issues/2021/0700/p49.html
Retrospective chart reviews document a variety of outcomes in patients with CRPS, from full resolution of symptoms to persistent, chronic pain that lasts for years. […] One study suggests that CRPS usually resolves spontaneously without treatment, although the time frame is not specified. […] Two studies showed that only a minority of patients develop chronic and severely disabling symptoms. A Dutch study showed severe progression of symptoms in 16% of patients, and 54% of patients were stable. Of the 54 out of 102 patients who were working before the CRPS diagnosis, 41% returned to work without restrictions, 28% returned to work with some restrictions, and 31% were not able to return to work. […] A population-based study in the United States showed resolution of symptoms in 74% of patients.
#25 Psychosocial factors associated with poor outcomes after amputation for complex regional pain syndrome type-I | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0213589
Poor outcomes of amputation in longstanding therapy resistant CPRS-1 are associated with psychological factors. […] Four of the 11 psychological factors were associated with poor outcomes. […] Reduction of worst pain in the last week was less in participants with a poor social support. […] Participants with low resilience perceived a less important improvement in mobility score. […] A psychiatric disorder or a history of a psychiatric disorder was associated with reported and observed recurrence somewhere else. […] The risk factors identified in this study are also not sensitive. […] The data of this study do not support the assumed role of psychological factors or psychiatric disorders in the etiology, development and maintenance of CPRS-I. They do support the assumed role of psychological factors in rehabilitation.
#26 Psychosocial factors associated with poor outcomes after amputation for complex regional pain syndrome type-I | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0213589
Poor outcomes of amputation in longstanding therapy resistant CPRS-1 are associated with psychological factors. […] Four of the 11 psychological factors were associated with poor outcomes. […] Reduction of worst pain in the last week was less in participants with a poor social support. […] Participants with low resilience perceived a less important improvement in mobility score. […] A psychiatric disorder or a history of a psychiatric disorder was associated with reported and observed recurrence somewhere else. […] The risk factors identified in this study are also not sensitive. […] The data of this study do not support the assumed role of psychological factors or psychiatric disorders in the etiology, development and maintenance of CPRS-I. They do support the assumed role of psychological factors in rehabilitation.
#27 Psychosocial factors associated with poor outcomes after amputation for complex regional pain syndrome type-I | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0213589
Poor outcomes of amputation in longstanding therapy resistant CPRS-1 are associated with psychological factors. […] Four of the 11 psychological factors were associated with poor outcomes. […] Reduction of worst pain in the last week was less in participants with a poor social support. […] Participants with low resilience perceived a less important improvement in mobility score. […] A psychiatric disorder or a history of a psychiatric disorder was associated with reported and observed recurrence somewhere else. […] The risk factors identified in this study are also not sensitive. […] The data of this study do not support the assumed role of psychological factors or psychiatric disorders in the etiology, development and maintenance of CPRS-I. They do support the assumed role of psychological factors in rehabilitation.
#28 Psychosocial factors associated with poor outcomes after amputation for complex regional pain syndrome type-I | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0213589
Poor outcomes of amputation in longstanding therapy resistant CPRS-1 are associated with psychological factors. […] Four of the 11 psychological factors were associated with poor outcomes. […] Reduction of worst pain in the last week was less in participants with a poor social support. […] Participants with low resilience perceived a less important improvement in mobility score. […] A psychiatric disorder or a history of a psychiatric disorder was associated with reported and observed recurrence somewhere else. […] The risk factors identified in this study are also not sensitive. […] The data of this study do not support the assumed role of psychological factors or psychiatric disorders in the etiology, development and maintenance of CPRS-I. They do support the assumed role of psychological factors in rehabilitation.
#29 Psychosocial factors associated with poor outcomes after amputation for complex regional pain syndrome type-I | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0213589
Poor outcomes of amputation in longstanding therapy resistant CPRS-1 are associated with psychological factors. […] Four of the 11 psychological factors were associated with poor outcomes. […] Reduction of worst pain in the last week was less in participants with a poor social support. […] Participants with low resilience perceived a less important improvement in mobility score. […] A psychiatric disorder or a history of a psychiatric disorder was associated with reported and observed recurrence somewhere else. […] The risk factors identified in this study are also not sensitive. […] The data of this study do not support the assumed role of psychological factors or psychiatric disorders in the etiology, development and maintenance of CPRS-I. They do support the assumed role of psychological factors in rehabilitation.
#30 Complex regional pain syndrome – Wikipedia
https://en.wikipedia.org/wiki/Complex_regional_pain_syndrome
Some cases of CRPS may resolve spontaneously, with 74% of patients in a Minnesota study experiencing complete symptom resolution, while others may have chronic or relapsing-and-remitting disease. […] Once one is diagnosed with CRPS, should it go into remission, the likelihood of it resurfacing after remission is considerable. Taking precautions and seeking immediate treatment upon any injury is important.
#31 Complex regional pain syndrome – Wikipedia
https://en.wikipedia.org/wiki/Complex_regional_pain_syndrome
Some cases of CRPS may resolve spontaneously, with 74% of patients in a Minnesota study experiencing complete symptom resolution, while others may have chronic or relapsing-and-remitting disease. […] Once one is diagnosed with CRPS, should it go into remission, the likelihood of it resurfacing after remission is considerable. Taking precautions and seeking immediate treatment upon any injury is important.
#32 Prognosis with CRPS Cases
https://www.crpslawsuit.com/prognosis/
If complex regional pain syndrome (CRPS) is identified and treated early, the chances of a positive prognosis for the patient increase significantly. The ideal time for treatment to begin is within the first 3 months; in many cases, however, patients have not yet been diagnosed within this timeframe. The longer treatment is delayed, the worse the outcome will likely be. […] If the disorder is allowed to progress untreated for too long, the consequences may be irreversible. CRPS can quickly spread from an extremity to negatively affect the entire limb. If this happens, the limb may experience bone degradation and nerve damage over time, as well as structural damage to muscles and tendons. […] If CRPS is diagnosed early and treatment begins as soon as possible, however, there is a chance that the disorder may go into remission. With treatment, a sufferer may experience as many as 5 years of remission or more before the effects of CRPS return. Sadly, there is no cure for RSD or causalgia, and while the symptoms may be pushed back for a time, they do return. […] The key to having a good prognosis with CRPS is to continue treatment and not give up. The temptation to give in to extraordinary pain and let the affected limbs simply waste away is strong, but the way to living an active lifestyle with the debilitating pain of CRPS has already been paved.
#33 Journal of Rehabilitation Medicine – Prognostic factors in complex regional pain syndrome 1: A systematic review – HTML
https://www.medicaljournals.se/jrm/content/html/10.2340/16501977-1103
The aim of this systematic review was to merge and summarize the current evidence about prognostic factors relevant to the course of complex regional pain syndrome 1. […] A total of 28 prognostic factors was identified. Sensory disturbances and cold skin temperature appear to represent parameters associated with poor prognosis in complex regional pain syndrome 1. […] Evidence about prognostic factors for complex regional pain syndrome 1 is scarce, which prevents firm conclusions being drawn. […] Clinical manifestations, such as the presence of cold skin temperature and sensory disturbances, seem to represent parameters associated with a poor prognosis in CRPS 1. […] We found no study developing or validating a prognostic instrument to identify patients with poor CRPS 1 prognosis. […] The current evidence is weak, and consistency was found only for negative predictive features, such as sensory disturbances and cold skin temperature.
#34 Journal of Rehabilitation Medicine – Prognostic factors in complex regional pain syndrome 1: A systematic review – HTML
https://www.medicaljournals.se/jrm/content/html/10.2340/16501977-1103
The aim of this systematic review was to merge and summarize the current evidence about prognostic factors relevant to the course of complex regional pain syndrome 1. […] A total of 28 prognostic factors was identified. Sensory disturbances and cold skin temperature appear to represent parameters associated with poor prognosis in complex regional pain syndrome 1. […] Evidence about prognostic factors for complex regional pain syndrome 1 is scarce, which prevents firm conclusions being drawn. […] Clinical manifestations, such as the presence of cold skin temperature and sensory disturbances, seem to represent parameters associated with a poor prognosis in CRPS 1. […] We found no study developing or validating a prognostic instrument to identify patients with poor CRPS 1 prognosis. […] The current evidence is weak, and consistency was found only for negative predictive features, such as sensory disturbances and cold skin temperature.
#35 Journal of Rehabilitation Medicine – Prognostic factors in complex regional pain syndrome 1: A systematic review – HTML
https://www.medicaljournals.se/jrm/content/html/10.2340/16501977-1103
The aim of this systematic review was to merge and summarize the current evidence about prognostic factors relevant to the course of complex regional pain syndrome 1. […] A total of 28 prognostic factors was identified. Sensory disturbances and cold skin temperature appear to represent parameters associated with poor prognosis in complex regional pain syndrome 1. […] Evidence about prognostic factors for complex regional pain syndrome 1 is scarce, which prevents firm conclusions being drawn. […] Clinical manifestations, such as the presence of cold skin temperature and sensory disturbances, seem to represent parameters associated with a poor prognosis in CRPS 1. […] We found no study developing or validating a prognostic instrument to identify patients with poor CRPS 1 prognosis. […] The current evidence is weak, and consistency was found only for negative predictive features, such as sensory disturbances and cold skin temperature.
#36 Psychosocial factors associated with poor outcomes after amputation for complex regional pain syndrome type-I | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0213589
Poor outcomes of amputation in longstanding therapy resistant CPRS-1 are associated with psychological factors. […] Four of the 11 psychological factors were associated with poor outcomes. […] Reduction of worst pain in the last week was less in participants with a poor social support. […] Participants with low resilience perceived a less important improvement in mobility score. […] A psychiatric disorder or a history of a psychiatric disorder was associated with reported and observed recurrence somewhere else. […] The risk factors identified in this study are also not sensitive. […] The data of this study do not support the assumed role of psychological factors or psychiatric disorders in the etiology, development and maintenance of CPRS-I. They do support the assumed role of psychological factors in rehabilitation.
#37 Complex regional pain syndrome what is the outcome? â a systematic review of the course and impact of CRPS at 12 months from symptom onset and beyond
https://pmc.ncbi.nlm.nih.gov/articles/PMC9324966/
Twentytwo included studies suggest that pain and motor dysfunction are the most dominant longterm features of CRPS, persisting for 51%89% of patients at 12 months. […] Results provide firsttime quantitative data including specific evidence about losses to motor function and longterm compromises to work status. […] Results demonstrate that the ongoing impact of one episode of CRPS on limb function and work status is relatively high. […] This review provides firsttime clarity in relation to outcomes of limb function and work status associated with an episode of CRPS, beyond 12 months from onset. […] Results demonstrate that the longterm impact of an episode of CRPS on these outcomes is much larger than previously described, and thus also illustrates how the wider health economic impact of CRPS is not yet fully understood.