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Evidence based guidelines for complex regional pain syndrome type 1

Roberto S Perez123*, Paul E Zollinger4, Pieter U Dijkstra5, Ilona L Thomassen-Hilgersom6, Wouter W Zuurmond1, Kitty CJ Rosenbrand7, Jan H Geertzen5 and the CRPS I task force

Author affiliations

1 VU University Medical Center, dept of Anaesthesiology, Amsterdam, the Netherlands

2 Research consortium Trauma Related Neuronal Dysfunction (TREND), the Netherlands

3 The EMGO Institute for Health and Care Research, Amsterdam, the Netherlands

4 Rivierenland Hospital, dept of Orthopaedic Surgery, Tiel, the Netherlands

5 University Medical Centre Groningen, Center for Rehabilitation, University of Groningen, Groningen, the Netherlands

6 Dutch Association of Posttraumatic Dystrophy Patients, Nijmegen, the Netherlands

7 Dutch Institute for Healthcare Improvement CBO, Utrecht, the Netherlands

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Citation and License

BMC Neurology 2010, 10:20  doi:10.1186/1471-2377-10-20

Published: 31 March 2010



Treatment of complex regional pain syndrome type I (CRPS-I) is subject to discussion. The purpose of this study was to develop multidisciplinary guidelines for treatment of CRPS-I.


A multidisciplinary task force graded literature evaluating treatment effects for CRPS-I according to their strength of evidence, published between 1980 to June 2005. Treatment recommendations based on the literature findings were formulated and formally approved by all Dutch professional associations involved in CRPS-I treatment.


For pain treatment, the WHO analgesic ladder is advised with the exception of strong opioids. For neuropathic pain, anticonvulsants and tricyclic antidepressants may be considered. For inflammatory symptoms, free-radical scavengers (dimethylsulphoxide or acetylcysteine) are advised. To promote peripheral blood flow, vasodilatory medication may be considered. Percutaneous sympathetic blockades may be used to increase blood flow in case vasodilatory medication has insufficient effect. To decrease functional limitations, standardised physiotherapy and occupational therapy are advised. To prevent the occurrence of CRPS-I after wrist fractures, vitamin C is recommended. Adequate perioperative analgesia, limitation of operating time, limited use of tourniquet, and use of regional anaesthetic techniques are recommended for secondary prevention of CRPS-I.


Based on the literature identified and the extent of evidence found for therapeutic interventions for CRPS-I, we conclude that further research is needed into each of the therapeutic modalities discussed in the guidelines.