IDIOPATHIC COMPLEX REGIONAL PAIN SYNDROME (CRPS): A CASE SERIES

Complex regional pain syndrome (CRPS) is a rare disorder that presents with motor, sensory, sudomotor, and vasomotor symptoms and favors females in a 2:1-4:1 ratio. This syndrome can be idiopathic without identifiable nerve damage, classified as CRPS I, or occur following trauma or surgery with associated nerve injury, classified as CRPS II. Physiotherapy is the first-line therapy, along with adjunct pharmacotherapy utilized including non-steroidal anti-inflammatory drugs (NSAIDs), bisphosphonates, calcitonin, and other pain management modalities. This study was a retrospective review of the nuclear medicine archives at the Jordan university hospital to identify bone scintigraphy studies performed for suspected CRPS cases. We identified 118 studies, among whom 67 studies were consistent with secondary CRPS and only 5 were idiopathic CRPS. All five patients were females with a mean age of 23.8 years, with typical symptoms of characteristic pattern of sensory, vasomotor, sudomotor, and motor/trophic dysfunction. One patient was diagnosed with depression at the same time as CRPS presentation, and treatment of her concomitant depression resulted in complete resolution of her symptoms. Only one out of the four patients were referred to physiotherapy, with persistent long-term disability. In conclusion, idiopathic CRPS appears to be rare and under-recognized, particularly in young female patients. Improved referral to physiotherapy and greater attention to comorbid conditions may enhance outcomes.