Etiology

There is no single theory that explains the intricate presentation of CRPS, usually initiated by a noxious event that is disproportionate to the ensuing pain, and several mechanisms have been proposed including neurological disorder,48[V] inflammation,49[V] sympathetic nervous system dysregulation,50[V], 51 [III] anticipatory pain and immobilization (fear avoidance),52[V] genetic predisposition, higher incidence associated with histocompat-ability antigens HLA-DQ1 and HLA-A3, B7, and DR2,53 [III], 54[III] and sensitization of the neurons at various levels of integration from the periphery to central nervous system.55[III], 56[III], 57[III]

Psychological factors are implicated in the causation and/or maintenance of CRPS 1 because the proposed mechanisms outlined above fail to account fully for the patient's pain and are considered by some as a somato-form pain disorder; somatoform pain disorders may account for some of the cases, but certainly do not account for all CRPS sufferers.58[V], 59[V], 60

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