Category Archives: Statistics of CRPS

CRPS Is Not ‘Rare’ In Fracture Patients

An important update on 29 April 2017 (regarding good news about Chantelle Baxter):

Great news!!  Chantelle Baxter is finally on the road to recovery from CRPS!

https://painmatters.wordpress.com/2017/04/29/woohoo-australias-one-girl-chantelle-baxter-is-finally-on-the-road-to-recovery-from-crps/

I am so thrilled and happy for her!  We need many more stories like this!

 

Dear Pain Matters readers,

Complex regional pain syndrome (CRPS) is often said to be ‘very rare’.

However, one does not have to look far to read or hear about someone with this medical condition.

My previous blog posts introduced 2 young and courageous women:

  • A Canadian named Paula Orecklin (29) from Winnipeg (nicknamed ‘Winterpeg’, for obvious reasons) (see bottom for links); and
  • An Australian named Chantelle Baxter (32), from ‘The Land Down Under’, Melbourne, Australia (see bottom for link).

While Paula and Chantelle grew up in 2 very different parts of the world, 15,000 km away from each other, both women share at least one thing in common.

On behalf of all Canadians living with chronic pain, Paula Orecklin was formally selected to be an Olympic torchbearer for the 2010 Vancouver Olympic Winter Games.  What an honour this is!

Meanwhile, Chantelle Baxter set a goal to educate one million (1,000,000!) girls in Africa by 2020!

Not only are both women truly amazing and inspirational, but sadly, both women also share a very painful medical condition called complex regional pain syndrome (CRPS).

How many others are there in this world just like Paula and Chantelle who are battling CRPS at this very moment??

Statistics of CRPS in Fracture Patients

The following 4 medical papers offer some insight into the incidence of CRPS in fracture patients.  Specifically, these studies state that CRPS may arise in (anywhere from) 7% to 48.5% (ie almost half!) of all fracture patients following fracture and treatment.

(1) A Korean study showed that 42 of 477 (ie 8.8%) of all surgically-treated wrist fracture patients developed CRPS1. Specifically, females with a high energy wrist trauma or a severe comminuted fracture had the highest risk of developing CRPS1 after surgery (Roh et al, 2014).

(2) A Dutch study reported similar results, whereby 7% (42 of 596) of all fracture patients developed CRPS1 following ER treatment (using the Harden and Bruehl diagnostic criteria). Alternatively, if the IASP diagnostic criteria for CRPS1 are applied, 48.5% (ie 289 of the same 596 fracture patients) had CRPS1 after treatment. Meanwhile, if the Veldman criteria were used, 21.3% of the same fracture patients (ie 127 of 596) developed CRPS1 after treatment. Thus, depending on the diagnostic criteria used for CRPS1, between 7% to almost half (!) of all 596 fracture patients developed painful CRPS1 following treatment.

Furthermore, all patients who developed CRPS1 after fracture and treatment still had ongoing severe pain and other CRPS1 symptoms that persisted even at 1-year follow-up. The Dutch researchers added that those who sustained an ankle fracture, dislocation or intra-articular fracture were at highest risk of developing painful CRPS1 (Beerthuizen et al, 2012).

(3) A Tunesian study reported that CRPS1 occurred in 32.2% (29 of 90) of all distal radius fracture patients following treatment involving closed reduction and casting. In other words, CRPS1 occurred in almost 1 in 3 distal radius fracture patients during the 3rd and 4th week after cast removal! Those at highest risk were females who reported severe pain and impairment of physical quality of life following comminuted, operated and casted wrist fractures (Jellad et al, 2014).

(4) An Italian study reported that CRPS occurred in anywhere from 1% to 37% of all fractures following orthopedic surgery, depending on the severity of the fracture. Patients at highest risk were women, older people, smokers and those with reduced bone strength. Early diagnosis is linked with remission in up to 90% of all cases. Where diagnosis of CRPS was delayed, electroanalgesia (e.g. spinal cord stimulation) sometimes offered promising results (Corradini et al, 2015).

I don’t know about you … but if the number of fracture patients who develop CRPS varies anywhere from 7% to almost half (!) of all fracture patients (depending on the criteria used to diagnose CRPS), this certainly does not sound like a ‘rare’ condition.

Summary

The good news is that if diagnosed and treated early, recovery from CRPS is likely.  Having said this, part or full recovery from CRPS is still possible in some cases even if diagnosed later (see large, 6-page Table in our review paper; Walker and Drummond, 2011).

Here’s to hoping that these statistics hit home with a strong message that CRPS is not rare, especially in fracture patients.  Complex regional pain syndrome does not discriminate based on age, gender, culture, race, skin colour, religion or any other criteria.

Clearly, the goals should be:

  • Early diagnosis of CRPS.  If unsure, pain and other medical specialists may be helpful with diagnosis;
  • Prompt referral to pain and other medical specialists;
  • Timely and effective treatment for CRPS; and
  • Regular follow-up until pain and other symptoms of CRPS are properly managed and/or reversed altogether.

Continuing research into CRPS is warranted.

After all, there may be a lot more ‘Paula’s’ and ‘Chantelle’s’ in this world battling CRPS than originally thought!

Sabina Walker, Pain Matters blogger

REFERENCES  

Incidence of CRPS following Fracture

(1) Roh YH, Lee BK, Noh JH et al. Factors associated with complex regional pain syndrome type I in patients with surgically treated distal radius fracture. Arch Orthop Trauma Surg (Dec 2014); 134(12): 1775-1781.

doi: 10.1007/s00402-014-2094-5

https://www.ncbi.nlm.nih.gov/pubmed/25311113

(2) Beerthuizen A, Stronks DL, Van’t Spijker A, Yaksh A, Hanraets BM, Klein J, Huygen FJ. Demographic and medical parameters in the development of complex regional pain syndrome type 1 (CRPS1): prospective study on 596 patients with a fracture. Pain (June 2012); 153(6): 1187–1192.

doi:10.1016/j.pain.2012.01.026

http://rsds.org/wp-content/uploads/2014/12/Demographic-medical-parameters.pdf
https://www.ncbi.nlm.nih.gov/pubmed/22386473

(3) Jellad A, Salah S, Ben Salah Frih Z. Complex regional pain syndrome type I: incidence and risk factors in patients with fracture of the distal radius. Arch Phys Med Rehabil (March 2014); 95(3): 487-492.

doi: 10.1016/j.apmr.2013.09.012.

https://www.ncbi.nlm.nih.gov/pubmed/24080349

(4) Corradini C, Bosizio C, Moretti A. Algodystrophy (CRPS) in minor orthopedic surgery. Clinical Cases in Mineral and Bone Metabolism (2015); 12(Suppl 1): 21-25.

doi: 10.11138/ccmbm/2015.12.3s.021.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4832412/

Examples of Patients who have Partly or Fully Recovered from CRPS following Anti-Inflammatory Treatment

(5) Walker, Sabina, Drummond, Peter D. Implications of a Local Overproduction of Tumor Necrosis Factor-α in Complex Regional Pain Syndrome [Review Paper]. Pain Medicine (Dec 2011); 12(12): 1784–1807 (24 pages).

(See large, 6-page table on pages 1791 – 1796.)

http://onlinelibrary.wiley.com/doi/10.1111/j.1526-4637.2011.01273.x/abstract

CRPS Patients Discussed in this Pain Matters Blog

(6) Paula Orecklin

https://painmatters.wordpress.com/2017/04/10/lets-talk-to-an-inspirational-young-woman-paula-orecklin-about-crps-sativex-physiotherapy-and-neuroplasticity/

https://painmatters.wordpress.com/2017/04/11/happy-disabiliday-on-april-1-a-letter-to-you-all-from-paula-orecklin-a-crps-patient-from-canada/

(7) Chantelle Baxter

https://painmatters.wordpress.com/2017/04/23/one-girl-from-australia-named-chantelle-baxter-is-determined-not-to-let-crps-win/

(8) Four (4) CRPS Patients Including Paula Orecklin

https://painmatters.wordpress.com/2014/10/26/crps-video-on-crps-by-parc-a-crps-website/