Reflex sympathetic dystrophy, sympathetically maintained pain, and complex regional pain syndrome: diagnoses of inclusion, exclusion, or confusion?

Few painful conditions involving the hand and arm have engendered so much confusion and argument among clinicians and so much suffering in patients as reflex sympathetic dystrophy. Adding to this confusion is the recent proposal by the International Society for the Study of Pain to rename this group of pain conditions "complex regional pain syndrome" (CRPS). In this new terminology, the diagnosis of CRPS relies on clinical assessment alone, and the role of the sympathetic nervous system has been de-emphasized. Sympatholytic interventions are recommended only for the subgroup of patients with sympathetically maintained pain. This article discusses the clinical description of CRPS, reviews the diagnostic tests for this group of conditions, and discusses the lack of reliable data on therapeutic interventions due to poor diagnosis of patients.