By
Elodie Vaz | Published on March 10, 2026 | 3 min read
Long
relegated to the status of a rare complication, complex regional pain syndrome
(CRPS) remains a largely underestimated condition. Yet its consequences can be
major. The disorder is characterized by persistent and disabling pain, most
often affecting the limbs: wrist, shoulder, foot, or knee. It frequently occurs
after trauma, a sprain, tendinitis, or a surgical procedure.
In France,
nearly 50,000 people—women, men, and children—are believed to be affected.
Despite this prevalence, the condition is still poorly recognized and sometimes
inadequately managed. As Prof. Eric Viel, a pain medicine specialist, noted
during a press conference organized on March 4 at the National Academy of
Surgery: “CRPS encompasses a set of articular and peri-articular symptoms
dominated by persistent pain with a regional distribution that does not
correspond to either a dermatome or a specific nerve territory.”
Better
understanding for better management
In response
to this situation, the National Academy of Surgery brought together several
experts to review current knowledge on CRPS. The objective was to assess
developments in diagnosis, advances in the pathophysiological understanding of
the disease, and therapeutic strategies that could improve patient care.
Integrating
clinical perspectives
The
analyses presented rely on a multidisciplinary approach involving pain
specialists, orthopedic surgeons, and experts in physical and rehabilitation
medicine. Prof. Eric Viel emphasizes that algodystrophy is not a new condition:
“Complex regional pain syndrome was described in detail by Ambroise Paré as
early as the 15th century and later widely documented by Silas Weir Mitchell
during the American Civil War.”
Today,
diagnosis relies primarily on medical history and clinical examination, using
the Budapest criteria. The incidence of the disease ranges from 0.19% to 1.2%
after trauma or surgery, with prolonged immobilization of a limb being one of
the main contributing factors.
A
multifactorial condition still poorly understood
Knowledge
of the underlying pathophysiology has progressed considerably in recent years.
Researchers have highlighted the association between neurogenic inflammation
and dysfunction of the autonomic nervous system.
The release
of neuropeptides—such as substance P or calcitonin gene-related peptide
(CGRP)—leads to edema, redness, increased local temperature, and skin changes.
At the same time, abnormal adrenergic receptor reactivity contributes to the
vasomotor and sudomotor disturbances observed in patients.
Recent
studies also suggest the presence of specific microbiome signatures, as well as
circulating autoreactive IgM and IgG antibodies in some patients. The
hypothesis of a permissive genetic background has also been proposed.
From a
surgical perspective, Dr. Rémy Coulomb highlights the complexity of management.
“Complex regional pain syndrome is a rare but feared complication in orthopedic
surgery.” High-risk situations include trauma requiring prolonged
immobilization, planned surgery in patients with significant preoperative pain,
and repeat surgical procedures.
From a
therapeutic standpoint, management relies on a combined strategy aimed at three
objectives: pain control, functional recovery, and improvement of quality of
life. Certain drug classes have shown limited effectiveness—notably NSAIDs,
paracetamol, and weak opioids. Other options may be considered depending on the
case: corticosteroids in the presence of significant inflammation, gabapentin
for neuropathic pain, or intravenous bisphosphonates.
Non-pharmacological
approaches also play a central role. As emphasized by Prof. Arnaud Dupeyron,
current strategies prioritize early and active rehabilitation. “The objective
is to gradually restore function by encouraging movement, even in the presence of
pain.” Mirror therapy, motor imagery, graded exposure to movement, and
cognitive-behavioral therapies are now part of the therapeutic arsenal.
Toward
earlier and more coordinated management
Algodystrophy
illustrates the challenges posed by complex chronic pain conditions. However,
recent advances—both in pathophysiology and therapeutics—are paving the way for
more effective management based on a multidisciplinary and early approach.
In the
coming years, the challenge will be to improve clinician awareness and
integrate these new insights into structured decision-making algorithms, in
order to reduce functional sequelae and restore patients’ quality of life.
At a time
when research is exploring new therapeutic avenues—such as botulinum toxin,
transcranial magnetic stimulation, or implanted neurostimulation—CRPS
highlights how the understanding of chronic pain remains a critical field of
research in contemporary medicine.
Read next: Chronic pain in women: exploring the
immune pathway
About the Author – Elodie Vaz
Health journalist, CFPJ graduate (2023).
Élodie explores the marks diseases leave on bodies and, more broadly, on
human life. A registered nurse since 2010, she spent twelve years at patients’
bedsides before exchanging her stethoscope for a notebook. She now investigates
the links between environment and health, convinced that the vitality of life
cannot be reduced to that of human.
