Modern Management of Complex Regional Pain Syndrome: A Practical Evidence-Based Review for Hand and Upper Extremity Surgeons

Complex regional pain syndrome (CRPS) is a debilitating pain disorder that most commonly develops following fractures, surgery, peripheral nerve injury, or other trauma to an extremity. Although substantial progress has been made in understanding its underlying neurobiology, CRPS remains difficult to diagnose and treat because of its heterogeneous clinical presentation and the absence of a single universally effective therapy. Patients often experience pain disproportionate to the inciting event, accompanied by sensory disturbances, autonomic dysfunction, edema, motor impairment, and trophic changes that collectively impair limb function and quality of life. For hand and upper-extremity surgeons, delayed recognition may result in prolonged disability, while premature diagnosis may obscure alternative conditions requiring surgical intervention. This review synthesizes 22 full-text publications identified through a staged, Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-style screening pathway of 1,471 PubMed records. Current literature consistently supports a multidisciplinary, function-centered treatment strategy. Clinical diagnosis using the Budapest Criteria remains the foundation of evaluation, while imaging and ancillary investigations are primarily used to exclude competing diagnoses. Early patient education, desensitization, edema management, and supervised rehabilitation represent the cornerstone of treatment. Pharmacologic therapies, including corticosteroids, bisphosphonates, neuropathic pain medications, and selected intravenous therapies, may facilitate functional recovery in carefully selected patients, although the certainty of evidence varies considerably. Sympathetic blockade, ketamine infusion, spinal cord stimulation, and dorsal root ganglion stimulation are best considered adjunctive therapies for patients with persistent symptoms despite comprehensive conservative management. Current evidence favors a staged, multidisciplinary approach in which restoration of limb function serves as the primary therapeutic objective. Rehabilitation should begin as early as possible, while medications and interventional procedures should be used to facilitate participation in therapy rather than replace it. For hand and upper-extremity surgeons, prompt recognition, exclusion of alternative diagnoses, avoidance of unnecessarily prolonged immobilization, and coordinated multidisciplinary care remain the most important modifiable factors influencing patient outcomes.