Complex regional pain syndrome (CRPS), also known as Reflex Sympathetic Dystrophy (RSD) is a chronic and often debilitating pain condition that most often develops after trauma to a limb. Traumas include a crush injury, surgery, or a simple sprain.mcgillindex1

On McGill’s Pain Scale, CRPS/RSD is rated higher than Amputation, childbirth and non terminal cancer.

The exact cause of the disease is not known, it’s major feature is exaggerated pain response in the central nervous system.

According to an article published in Medifocus Digest Alert, of the many theories that have been proposed for the underlying mechanisms involved in the development of CRPS, there is some limited evidence for involvement of the immune system through the production of autoantibodies, primarily immunoglobulin G (IgG) autoantibodies, that attack the nervous system.

In a study published recently in Pain Physician, researchers from Drexel University School of Medicine in Philadelphia evaluated the efficacy of plasma exchange (PE) therapy in 33 patients with CRPS. Plasma exchange therapy, also known asplasmapheresis, involves the removal of whole blood from a patient which is then separated by a technique called centrifugation into plasma (the liquid portion of blood) andblood cells. The plasma is removed and replaced with another solution, such as donor plasma or human albumin, and is then returned to the patient via a central line. Plasma exchange therapy is employed for the treatment of a variety of conditions and is generally used when a substance in the plasma, such as immunoglobulin, is acutely toxic and causes serious conditions such as Guillain-Barre syndrome, myasthenia gravis, or thrombocytic thrombocytopenia purpura (among others).

In the study, 33 patients with documented CRPS underwent an initial series of PE treatments over a 2 to 3 week period. At the end of the initial treatment phase, those patients who elected to continue with treatment received PE twice a week for a month followed by a maintenance protocol of once a week PE therapy.

The results of the study indicated that 30 of the 33 patients experienced a significant median pain reduction of 64% compared to baseline following the initial series of PE treatments. All 20 of the patients who elected to continue PE therapy beyond the initial phase also experienced a significant reduction in pain compared to before starting PE therapy. In addition, 8 patients who had responded previously to PE therapy were placed on oral immunosuppressant medications with either mycophenolate mofetil, adalimumab, or prednisone. Although 7 of these 8 patients have discontinued PE therapy, the pain reduction in these patients has been maintained with oral immunosuppressants.

For more information on this promising study, visit Pain Physician.


Reference: Plasma exchange therapy in patients with complex regional pain syndrome. Pain Physician. Volume 18; pages 383-394. 2015