Complex regional pain syndrome 1 : a study on pain and motor impairments
Complex Regionaal Pijn Syndroom 1: een studie naar pijn en motorische stoornissen
This thesis, is compiled of publications on reflex sympathetic dystrophy (RSD) or Complex Regional Pain Syndrome type 1 (CRPS 1), as it was renamed by the committee on taxonomy of the International Association for the Study of Pain (IASP). It is a puzzling syndrome both from a clinical point of view as well as in the perspective of basic pain science. Therapies rendered may vary and include physical therapy, occupational therapy, physical immobilization, surgical or chemical sympathectomies, pharmacotherapy and psychological treatment. A well accepted treatment algorithm is lacking and treatment regimens hardly seem driven by the progress made in basic pain science. The leading thread of this thesis is the concept of CRPS 1 as a neuropathic pain syndrome of unknown etiology involving multiple and timedependent mechanisms. It is discussed that besides the affected extremity also spinal and suprapinal structures may become involved. The scope of the publications varies from clinical studies on pain management performed in the context of an interdisciplinary rehabilitation team, to experimental studies on motor impairments and immunology. The clinical and experimental work was at least partly performed before the introduction of the t= complex regional pain syndrome 1. It is for this reason that the reader may encounter the t= reflex sympathetic dystrophy in some chapters.