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Complex regional pain syndrome (CRPS) and bone marrow edema syndrome (BMES) are two rare conditions that are still being discussed. They are generally considered as two distinct entities, yet they share similarities such as a homogeneous bone marrow edema is also often found in the early phase of CRPS. We present the case of a 41-year-old man with CRPS after a foot fracture followed by the development of painful BMES of the ipsilateral knee and hip a few weeks later. The search for another pathology was negative. After pamidronate infusions, the evolution was spectacular: the disappearance of hip pain at 1 month and more than 50% reduction in knee and foot pain at 2 months. At final follow-up (1 year), the patient was asymptomatic. This case reinforces the idea of a possible link between CRPS and BMES probably through similar trabecular bone involvement. Imaging remains useful in diagnosis of CRPS., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: First, to determine the number of accident-related complex regional pain syndrome (CRPS) cases from 2008 to 2015 and to identify factors associated with an increased risk for developing CRPS. Second, to analyze the duration of work incapacity and direct health care costs over follow-up periods of two and five years, respectively., Design: Retrospective data analysis., Setting: Database from the Statistical Service for the Swiss National Accident Insurances covering all accidents insured under the compulsory Swiss Accident Insurance Law., Subjects: Subjects were registered after an accident between 2008 and 2015., Methods: Cases were retrospectively retrieved from the Statistical Service for the Swiss National Accident Insurances. Cases were identified using the appropriate International Classification of Diseases, 10th Revision, codes., Results: CRPS accounted for 0.15% of all accident cases. Age, female gender (odds ratio [OR] = 1.53, 95% confidence interval [CI] = 1.47-1.60), and fracture of the forearm (OR = 38, 95% CI = 35-42) were related to an increased risk of developing CRPS. Over five years, one CRPS case accumulated average insurance costs of $86,900 USD and treatment costs of $23,300 USD. Insurance costs were 19 times and treatment costs 13 times the average costs of accidents without CPRS. Within the first two years after the accident, the number of days lost at work was 20 times higher in patients with CRPS (330 ± 7 days) than in patients without CRPS (16.1 ± 0.1 days). Two-thirds of all CRPS cases developed long-term work incapacity of more than 90 days., Conclusion: CRPS is a relatively rare condition but is associated with high direct health care costs and work incapacity., (© 2019 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

The Complex Regional Pain Syndrome (previously algodystrophy) is a rare affliction that usually affects a distal extremity (hand, foot). It occurs most frequently within weeks following a traumatic injury or stroke. It is a syndromic entity whose diagnosis is based on precise criteria, known as the Budapest criteria, excluding any disease that better explains the symptoms. The treatment must be given early. Functional restoration (physiotherapy, occupational therapy) is at the heart of the treatment, along with psychoeducation. Inappropriate disuse and avoidance, often encountered, must be combated. Bisphosphonates or steroids are first-line drugs at early stages. The evolution is often long, but the prognosis is favorable in about 75 % of cases (≤ 1 year)., Competing Interests: les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Objectives: To develop and test a new immersive digital technology for complex regional pain syndrome (CRPS) that combines principles from mirror therapy and immersive virtual reality and the latest research from multisensory body processing., Methods: In this crossover double-blind study, 24 patients with CRPS and 24 age- and sex-matched healthy controls were immersed in a virtual environment and shown a virtual depiction of their affected limb that was flashing in synchrony (or in asynchrony in the control condition) with their own online detected heartbeat (heartbeat-enhanced virtual reality [HEVR]). The primary outcome measures for pain reduction were subjective pain ratings, force strength, and heart rate variability (HRV)., Results: HEVR reduced pain ratings, improved motor limb function, and modulated a physiologic pain marker (HRV). These significant improvements were reliable and highly selective, absent in control HEVR conditions, not observed in healthy controls, and obtained without the application of tactile stimulation (or movement) of the painful limb, using a readily available biological signal (the heartbeat) that is most often not consciously perceived (thus preventing placebo effects)., Conclusions: Next to these specific and well-controlled analgesic effects, immersive HEVR allows the application of prolonged and repeated doses of digital therapy, enables the automatized integration with existing pain treatments, and avoids application of painful bodily cues while minimizing the active involvement of the patient and therapist., Classification of Evidence: This study provides Class III evidence that HEVR reduces pain and increases force strength in patients with CRPS., (© 2018 American Academy of Neurology.)

Background: The Constant-Murley Score (CMS) is a relatively unique shoulder assessment tool because it combines patient-reported outcomes (pain and activity), performance measurement and clinician-reported outcomes (strength and mobility). With these characteristics, the effect of patient-related psychological factors on the CMS remains debated. We aimed to investigate which parameters of the CMS are influenced by psychological factors by assessing the CMS before and after rehabilitation for chronic shoulder pain. Methods: This retrospective study screened all patients (18–65 years old) who were admitted for interdisciplinary rehabilitation for chronic shoulder pain (≥ 3 months) between May 2012 and December 2017. Patients with unilateral shoulder injuries were eligible. Exclusion criteria were shoulder instability, concomitant neurological injuries, complex regional pain syndrome (including Steinbrocker syndrome), heavy psychiatric issues, and missing data. The Hospital Anxiety and Depression Scale, Pain Catastrophizing scale, and Tampa Scale of Kinesiophobia were administered before and after treatment. Regression models were used to estimate associations between psychological factors and the CMS. Results: We included 433 patients (88% male, mean age 47±11 years) with a median duration of symptoms of 392.2 days (interquartile range: 266.5-583.5). Rotator cuff issue was present in 71% of patients. During interdisciplinary rehabilitation, patients were followed for a mean of 33.6±7.5 days. The mean CMS at entry was 42.8 ±15.5. The mean gain in CMS after treatment was 10.6 ±10.9. Before treatment, psychological factors were significantly associated with only the pain CMS parameter: -0.37 (95% CI: -0.46 to -0.28), p <0.001. After treatment, psychological factors were associated with the evolution of the four CMS parameters: -0.12 (-0.23 to -0.01) to -0.26 (95% CI: -0.36 to -0.16), p<0.05. Conclusions: This study raises the question of a distinct assessment of pain when assessing shoulder function with CMS in patients with chronic shoulder pain. The separation of the "pain parameter" from the overall CMS score seems illusory with this tool that is used worldwide. However, clinicians should be aware that psychological factors can negatively influence the evolution of all CMS parameters during follow-up, which argues for a biopsychosocial approach to patients with chronic shoulder pain. [ABSTRACT FROM AUTHOR]

Purpose: To assess and compare the healthcare costs, time to fitness for work (TFW) between chronic complex regional pain syndrome (CRPS) and non-CRPS; and identify factors associated with these outcomes in a comparative longitudinal study. Patients and Methods: 148 patients with chronic CRPS of the hand and 273 patients with chronic hand impairments but without CRPS (non-CRPS) were admitted at a Swiss rehabilitation clinic between 2007 and 2016. Healthcare costs and TFW were retrieved from insurance data over 5 years after the accident. Socio-demographic factors, biopsychosocial complexity measured by means of the INTERMED questionnaire, pain intensity and DASH disability scores were collected during rehabilitation. Generalized estimation equations and Cox proportional-hazards models were used to identify factors associated with outcomes. Results: Healthcare costs were increased by 20% for the CRPS versus non-CRPS group (coefficient = 1.20, 95% CI = 1.08– 1.35, p< 0.001). The median TFW was longer for CRPS than non-CRPS patients (816 vs 672 days, p = 0.02). After adjusting for covariates, TFW did not differ between the two groups (hazard ratio = 0.94, 95% CI = 0.73– 1.21, p=0.61). For CRPS patients, higher healthcare costs were associated with severe or moderate initial injury, high INTERMED or DASH disability scores. Longer TFW were associated with severe initial injury, low educational level, no work contract, and high INTERMED or DASH disability scores. Conclusion: Overall, the healthcare costs were higher for CRPS than non-CRPS patients, but the TFW was comparable. We demonstrated also the significant associations of disability and biopsychosocial factors with the healthcare costs and TFW in CRPS patients. [ABSTRACT FROM AUTHOR]

Purpose: To compare the prevalence of psychiatric comorbidity between patients with complex regional pain syndrome (CRPS) of the hand and non-CRPS patients and to assess the association between biopsychosocial (BPS) complexity profiles and psychiatric comorbidity in a comparative study. Patients and Methods: We included a total of 103 patients with CRPS of the hand and 290 patients with chronic hand impairments but without CRPS. Psychiatric comorbidities were diagnosed by a psychiatrist, and BPS complexity was measured by means of the INTERMED. The odds ratios (OR) of having psychiatric comorbidities according to BPS complexity were calculated with multiple logistic regression (adjusted for age, sex, and pain). Results: Prevalence of psychiatric comorbidity was 29% in CRPS patients, which was not significantly higher than in non-CRPS patients (21%, relative risk=1.38, 95% CI: 0.95 to 2.01 p=0.10). The median total scores of the INTERMED were the same in both groups (23 points). INTERMED total scores (0– 60 points) were related to an increased risk of having psychiatric comorbidity in CRPS patients (OR=1.46; 95% CI: 1.23– 1.73) and in non-CRPS patients (OR=1.21; 95% CI: 1.13– 1.30). The four INTERMED subscales (biological, psychological, social, and health care) were correlated with a higher risk of having psychiatric comorbidity in both groups. The differences in the OR of having psychiatric comorbidity in relation to INTERMED total and subscale scores were not statistically different between the two groups. Conclusion: The total scores, as well as all four dimensions of BPS complexity measured by the INTERMED, were associated with psychiatric comorbidity, with comparable magnitudes of association between the CRPS and non-CRPS groups. The INTERMED was useful in screening for psychological vulnerability in the two groups. [ABSTRACT FROM AUTHOR]

Résumé: Objectif: L’objectif de cette étude est de comparer les caractéristiques de patients souffrants d’un syndrome douloureux régional complexe de type 1 (algodystrophie) du genou à celles d’un groupe apparié de patients avec des gonalgies post-traumatiques. Les comparaisons portent sur la complexité biopsychosociale (simple versus complexe), les comorbidités psychiatriques, l’intensité de la douleur. Méthodes: Étude transversale monocentrique, cas–témoins. Utilisation de l’échelle Intermed, diagnostics psychiatriques (CIM-10), échelle visuelle analogique de la douleur. Table de contingence, tests de Chi carré. Pour les variables dépendantes continues, analyse de variance à un facteur. Différence entre les groupes : test de Tukey, a posteriori. Pour les variables dépendantes nominales, analyse logistique multivariée. Résultats: La complexité biopsychosociale ne diffère pas dans les deux groupes (p =0,7). Les patients complexes présentent significativement plus de comorbidités psychiatriques (odds ratio 2,94, intervalle de confiance à 95 % de 1,1–7,8, p <0,01), indépendamment de la présence ou non d’une algodystrophie. La douleur perçue varie avec la complexité biopsychosociale uniquement dans le groupe témoin. Les patients témoins complexes rapportent davantage de douleurs que les patients témoins simples (p <0,05). L’intensité de la douleur perçue est comparable chez les patients algodystrophiques simples ou complexes. Conclusion: La complexité biopsychosociale est comparable dans les deux groupes. Elle est fortement reliée à la présence de comorbidités psychiatriques. En revanche, contrairement à d’autres syndromes douloureux, lors d’algodystrophie, l’intensité de la douleur perçue ne varie pas avec la complexité biopsychosociale. L’identification précoce de patients complexes pourrait permettre d’instaurer rapidement une prise en charge ciblée dans les deux groupes de patients. [Copyright &y& Elsevier]

Abstract: Aim: The aim of this study was to compare the characteristics of patients suffering from complex regional pain syndrome type 1 ([CRPS], also known as reflex sympathetic dystrophy or algodystrophy) of the knee with those of a matched group of patients experiencing post-traumatic knee pain. The comparisons looked at biopsychosocial complexity (simple versus complex), psychiatric comorbidity and pain intensity. Methods: Cross-sectional, single-centre, case-control study using the INTERMED scale, psychiatric diagnostic tools (ICD-10) and visual analogue pain scale. Contingency table and Chi2 tests. One-way analysis of variance for continuous dependent variables. Difference between groups: Tukey''s variance test, after the event. For nominal dependent variables, multivariate logistic analysis. Results: Biopsychosocial complexity did not differ between the two groups (p=0.7). The “complex” patients displayed significantly more psychiatric comorbidity (odds ratio 2.94, 95% confidence interval 1.1–7.8, p<0.01), independently of whether or not CRPS was present. The pain perceived varied with biopsychosocial complexity only in the control group. The “complex” control patients reported more pain than the “simple” control patients (p<0.05). The perceived intensity of pain was not different between the “simple” and “complex” patients with CRPS. Conclusions: Biopsychosocial complexity was comparable between the two groups, and was strongly associated with the presence of psychiatric comorbidity. However, unlike with other pain syndromes, with CRPS the intensity of the perceived pain did not vary with biopsychosocial complexity. Early identification of “complex” patients could make it possible to quickly institute targeted management for both groups of patients. [Copyright &y& Elsevier]