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Complex Regional Pain Syndrome: What's in a Name?

  • Terence J. Coderre
    Correspondence
    Address reprint requests to Dr Terence J. Coderre, Anesthesia Research Unit, 1203-3655 Promenade Sir William Osler, Montreal, QC, H3G 1Y6, Canada.
    Affiliations
    Department of Anesthesia and Alan Edward Centre for Research on Pain, McGill University, and McGill University Health Centre Research Institute, Montreal, Quebec
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      Abstract

      Within a 2-year period in the 1940s, 2 Boston physicians published dramatically opposing views on the underlying nature of a syndrome now known as complex regional pain syndrome (CRPS). Evans suggested, in several papers in 1946–1947, that sympathetic reflexes maintain pain and dystrophy in affected limbs. Foisie, in 1947, suggested arterial vasospasms were key in the etiology of this pain syndrome. Evans' hypothesis established the nomenclature for this syndrome for 60 years, and his term, “reflex sympathetic dystrophy,” guided clinical treatment and research activities over the same period. Foisie's proposed nomenclature was unrecognized, and had virtually no impact on the field. Recent evidence suggests that Evans' contribution to the field may have in fact led clinicians and researchers astray all those years. This focus article on CRPS compares recent observations with these 2 earlier theories and asks the question—what if we had adopted Foisie's nomenclature from the beginning?

      Perspective

      This article discusses 2 opposing historical views on the etiology of what is now known as CRPS, and how they affected nomenclature, research, and clinical therapy in subsequent decades. This focus article may help researchers and clinicians realize the importance of syndrome names, and how they may inadvertently misdirect research and treatment.

      Key words

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