Complex regional pain syndrome

Complex regional pain syndrome (CRPS) is divided into type I (without) and type II (with) nerve injury. These types occur as a consequence of major or minor trauma, and are often characterized by allodynia, hyperpathia, and autonomic signs. After partial nerve injury, there is expression of a-adrenoreceptors in the injured and uninjured axons, making them sensitive to nor-epinephrine.50,51 Also, the sympathetic axons which normally innervate blood vessels within the dorsal root ganglion sprout to form basket-like terminals around the cell bodies of sensory neurons.52 It may be postulated that sympathetic stimulation can activate these neurons repetitively.52 These types of pain can respond strikingly to sympatholytic procedures, such as sympathetic blocks (either at the sympathetic ganglia or intravenous gua-nethidine). Reflex sympathetic dystrophy and causalgia are now included in a more general term - complex regional pain syndrome. For further discussion of this topic, see Chapter 27, Complex regional pain syndromes.

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