Complex Regional Pain Syndrome (CRPS)

Das Complex regional Pain Syndrome (CRPS) oder früher Morbus Sudeck wird nach wie vor als eine Art „mystische“ Erkrankung angesehen. Trotz zahlreicher Studien und Leitlinien herrscht in der Versorgungsrealität oft Unsicherheit über das korrekte diagnostische und therapeutische Vorgehen, sodass die Fehldiagnoserate hoch und die Therapie oft nicht leitliniengerecht ist. Diese Übersicht soll als Update insbesondere den praxisrelevanten „State of the Art“ in Diagnostik und Therapie darstellen.

Abstract

The complex regional pain syndrome (CRPS) usually occurs within a few weeks in 2–5% of all patients after trauma or surgery or subsequent measures of the distal extremities. There are certain risk factors for its occurrence but no “CRPS personality”, instead there are factors that negatively influence the course. The prognosis is generally good (“rule of thirds”), but remaining limitations are common. The diagnosis is clinically possible according to the “Budapest criteria”. Additional examinations are possible in case of doubt but are neither conclusive nor exclusive. Corticoids and bisphosphonates are used alongside drugs that have an effect on neuropathic pain. Invasive therapies do not have good evidence and have therefore lost their importance. The rehabilitative therapy is carried out actively and with a lot of self-exercises at an early stage. Invasive anesthetic, passive therapies are obsolete. Special forms of treatment are “graded exposure” (GEXP) in the case of dominant anxiety and, e.g., “graded motor imagery” (GMI) in case of neglect-like symptoms. In addition to educational and behavioral therapy elements, psychotherapy for CRPS also includes participation as part of graded exposure.

Schlüsselwörter

Morbus Sudeck - Graded Motor Imagery - Graded Exposure - Budapest-Kriterien

Keywords

Sudeck's disease - graded motor imagery - graded exposure - Budapest criteria

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