|Remission and Recurrence of Complex Regional Pain Syndrome: Analysis of a Web-based Survey
M. Lesley1, D. Mazloomdoost1, S. Agarwal1, A. Sharma2, J. Broatch3, S. N. Raja1
1Johns Hopkins University, Department of Anesthesiology and Critical Care Medicine, Baltimore, United States, 2The Nexus Pain Center of Columbus, Columbus, United States, 3Reflex Sympathetic Dystrophy Syndrome Association of America, Milford, United States
Background and Aims: CRPS often leads to disability, though some patients experience remission. Little is known about frequency of remission and recurrence of CRPS, nor factors that predict which patients are likely to have a remission. Data from an Internet-based survey of patients diagnosed with CRPS was examined to determine frequency of remission and recurrence, and demographic information or clinical characteristics that predict remission.
Methods: CRPS patients who completed an initial survey on the Reflex Sympathetic Dystrophy Syndrome Association of America (RSDSA) website were invited to complete a second wide-ranging survey. Correlations were made using Chi-square or Fisher’s Exact tests and binomial logistic regression where appropriate.
Results: Of patients who completed the survey, 88.3% (264/299) were female and 44.8% (134/299) were between the ages of 45 and 55. Remission of symptoms were reported by 16.5% (44/266) of patients. Patients reporting benefit from sympathetic blocks were more likely to experience remission (X2(1, N=64) =6.409, p=0.011). Type or location of injury, demographics, time to diagnosis, and duration of symptoms were not statistically significant predictors of remission. Of those who reported remission, 84.1% (37/44) had recurrence of CRPS. Remission length varied from 0 to 20 years (mean 2.01, SD 4.10).
Conclusions: Remission of CRPS is difficult to predict based on demographic and clinical characteristics. The correlation between remission and improvement with sympathetic blocks suggests CRPS patients with sympathetically maintained pain are more likely to achieve remission. Remission is often transient, with most experiencing recurrence of symptoms.
Added February 17, 2009