Complex regional pain syndrome: New insight and therapeutic approach

Introduction/Background CRPS implies sympathetic, inflammatory, neurogenic, vascular, peripheral and central mechanisms. The pathophysiology of type 1 CRPS is complex and yet poorly understood. The relative part of each mechanism in CRPS type 1 development and resistance is not established, as their respective contribution varies amongst patients during the course of clinical evolution. A growing consensus has developped for a central participation to this pathology, even if the very nature of spatial and body representation alterations is still discussed. It has been clinically observed and repeatedly argued that CRPS implies pathological motor neglect. Material and method We reviewed the available literature about central pathophysiology and new therapeutic approaches and will illustrate new perspectives with our own clinical and research practice. Results Even if spatial cognition explorations has given rise to a variety of inconsistent results, it is now admitted that central participation, manifested as a spatial reference frame alteration plays a central role in CRPS. This new view blazed the trail to new therapeutic strategies targeting spatial reference frame alterations: mirror therapy, prism adaptation, rTMS. Conclusion Central participation to CRPS’ pathophysiology is nowadays admitted. Amongst the new therapeutic strategies rising from this recent comprehension, the most promising seems to be prismatic adaptation.