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Peripheral Nerve Surgery in Patients with a Label of Complex Regional Pain Syndrome in the Extremities

Year: 2025

Type: article

Abstract: BACKGROUND: The management of complex regional pain syndrome (CRPS) is challenging, and the optimal treatment pathway for these patients remains unclear. We describe the treatment trajectory for patients referred with a label of CRPS. STUDY DESIGN: We retrospectively analyzed 53 patients referred with a label of CRPS in the extremities at a tertiary care center from 2017 to 2024. Three clinicians conducted a retrospective Budapest criteria assessment to classify patients into 3 categories: (1) Budapest-confirmed CRPS, (2) inconclusive CRPS, or (3) Budapest-confirmed non-CRPS. Data on injury and treatment characteristics were recorded from chart review. Outcomes were recorded, defined as reported improvement in pain and/or function at the most recent visit. RESULTS: The median treatment duration was 3.9 years (interquartile range 2.2 to 6.6). Common treatment modalities included neuromodulators (91%), opioids (77%), and peripheral nerve surgery in 66% of patients. The overall rate of clinical improvement was 55%, with 67% of patients undergoing surgery reporting benefit. No statistically significant differences in treatments were observed across the 3 CRPS groups. Exploratory bivariate analysis identified factors associated with improvement: absence of emotional events affecting symptoms (p = 0.022), no opioid use (p = 0.024), no cannabinoid use (p = 0.019), surgery after referral (p < 0.001), and major limb amputation with primary targeted muscle reinnervation (p = 0.047). CONCLUSIONS: More than half of patients referred with a label of CRPS underwent surgical intervention, with 67% of surgical patients reporting improvement. With a median treatment duration of more than 3 years and frequent clinic visits, our findings underscore the need for an interdisciplinary, personalized approach and the importance of considering peripheral nerve surgery for select patients.

Source: Journal of the American College of Surgeons

DOI: 10.1097/xcs.0000000000001589

Authors: Floris V Raasveld, Margaux Wolff, Anna Luan, David Hao, Ian L Valerio, Kyle R Eberlin