HISTORY AND NOMENCLATURE

CRPS has gone through a progression of names. The first description of CRPS may have dated back to 1634 when King Charles IX suffered persistent pain following a bloodletting procedure.¹¹ In 1872 an American Civil War physician, Weir Mitchell described cases of a burning pain syndrome following gunshot wounds as causalgia.¹²

“We have some doubt as to whether this form of pain ever originates at the moment of wounding…Of the special cause, which provokes it, we know nothing, except that it has sometimes followed the transfer of pathological changes from a wounded nerve to unwounded nerves, and has then been felt in their distribution, so that we do not need a direct wound to bring it about. The seat of the burning pain is very various; but it never attacks the trunk, rarely the arm or thigh, and not often the forearm or leg. Its favorite site is the foot or hand…Its intensity varies from the most trivial burning to a state of torture, which can hardly be credited, but reacts on the whole economy, until the general health is seriously affected…The part itself is not alone subject to an intense burning sensation, but becomes exquisitely hyperanesthetic, so that a touch or tap of the finger increases the pain.” –Silas Weir Michell, 1872

In 1900, Paul Sudeck described an extremity pain syndrome which developed after bone fractures, which was referred to as Sudeck’s syndrome and in European countries as Sudeck’s Atrophy.¹³ Other names have included minor causalgia, post-traumatic pain syndrome, post-traumatic painful arthrosis, Sudeck’s dystrophy, post-traumatic edema, shoulder-hand syndrome, chronic traumatic edema, algodystrophy, peripheral trophoneurosis and sympathalgia.¹⁴ Based on the experience that some patients were obtaining relief from sympathetic blocks, the term Reflex Sympathetic Dystrophy (RSD) was introduced in 1946 by J.A. Evans to accommodate the role of the sympathetic nervous system.¹⁵ The term Sympathetically Maintained Pain was introduced in 1986 as a synonym of RSD.¹⁶ Then due to lack of pain relief in some patients after sympathetic block, the term sympathetically independent pain was used to describe pain states similar to RSD.¹⁷ In an effort to clarify the nomenclature, the International Association for the Study of Pain met in 1993 and came up with the term Complex Regional Pain Syndrome.¹⁸  (See Figure 2.)