Additions Required

Letters to the Editor Modern Principles of Diagnosis and Treatment in Complex Regional Pain Syndrome by Alexandra Melf-Marzi, Dr. med. Bettina Böhringer, Dr. med. Matthias Wiehle, and Prof. Dr. med. Constanze Hausteiner-Wiehle in issue 51–52/2022

I have some comments with regard to the condensed clinical-scientific review article (1).

• Much depends on the specific medical specialty from whose perspective complex regional pain syndrome (CRPS) is considered—the authors have a non-surgical, neurological-anesthesiologic perspective. As surgeons we have a different perspective, not only because we treat many limb injuries that sometimes trigger CRPS but because we use hand surgery in the setting of standard surgical procedures (carpal tunnel syndrome, annular ligament release for trigger finger) that can trigger CRPS.

The diagnosis of CRPS should not be used as the catch-all dustbin for unclear complaints of the limbs (2). Furthermore, CRPS can also be cured by peripheral surgery if a cause has actually been identified and consistently treated.

• In 20 years of serious observation I have never seen CRPS in patients with severe burns—is this because of stringent and early analgesia administration?
• Regarding the Budapest guidelines: I would be very pleased and welcome it if your article brought about a change in thinking in patients with pronounced pain syndromes in general (including CRPS). Pain and sensory impairments remain subjective characteristics that the guidelines acknowledge to an unsatisfactory degree—in my opinion—and that sustain the suspicion of (dis)simulation and aggravation. Many of our fellow human beings suffer as a result of the rational chains of reasoning of supposed experts. Your article opens up new perspectives in this setting (nociplasticity, neurocognition, developments in physical therapy and occupational therapy).
• Neurosurgical stimulation therapy remains a questionable surgical escalation—I would prioritize an extensive search for triggers. It comes into its own when pain therapists and neurologists have run out of ideas/options. But what happens if the stimulation probe slips, becomes ineffective, has a technical defect, the pain changes?

DOI: 10.3238/arztebl.m2023.0061

Dr. Jörg Bahm, PhD

Klinik für Plastische, Hand- und Verbrennungschirurgie am Universitätsklinikum Aachen

Conflict of interest statement

The author declares that no conflict of interest exists.

References

1. Melf-Marzi A, Böhringer B, Wiehle M, Hausteiner-Wiehle C: Modern principles of diagnosis and treatment in complex regional pain syndrome. Dtsch Arztebl Int 2022; 119: 879–86

2. Del Piñal F: Editorial. I have a dream [. . .] reflex sympathetic dystrophy (RSD or complex regional pain syndrome – CRPS I) does not exist. J Hand Surg Eur Vol 2013; 38: 595–7