Complex Regional Pain Syndrome — FRCA Final MCQ

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ModeratePain MedicineComplex Regional Pain SyndromeFRCA Final

A 35-year-old woman has complex regional pain syndrome type I affecting her right hand following a distal radius fracture 6 months ago. She has allodynia, oedema, skin colour change and restricted movement. Which intervention should form the foundation of her ongoing management?

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Correct answer: E — Physiotherapy and rehabilitation

The correct answer is E. CRPS management should be multidisciplinary, with active, graded rehabilitation directed at restoring limb use and function. This may include specialist physiotherapy or hand therapy, desensitisation, graded motor imagery and mirror therapy. Analgesic and psychological measures should facilitate participation in rehabilitation rather than replace it. A stellate ganglion block may occasionally be considered as an adjunct when pain prevents progress, but it is not foundational treatment. Intravenous regional guanethidine is ineffective and may cause significant adverse effects. Corticosteroids have limited evidence mainly in selected early inflammatory CRPS and are not the principal treatment six months after injury. Surgical sympathectomy is invasive, has uncertain durable benefit and is not routine management.

Reference: NHS, Complex regional pain syndrome – Treatment, last reviewed 2022, https://www.nhs.uk/conditions/complex-regional-pain-syndrome/treatment/