Monday, September 19th
8:30am-12:00pm EDT


Refresher Course


Chronic pain: Other


602 B

CRPS from Bedside to Bench

CRPS is an uncommon condition. For such reasons, it may be challenging for clinicians to gain experience and knowledge of the condition to provide adequate diagnostic assessment and intervention. These difficulties appear to apply worldwide. CRPS is also a complex condition, and the pathophysiology points to potentially multiple disease mechanisms, further compounding management. The aim of the refresher course is to re-train course attendees in the clinical presentation of CRPS including the variability in the clinical picture, and to describe the current understanding of CRPS pathophysiology based on the most recent research findings. Finally, the session will teach attendees about current and future therapies, provide some simple tools for the assessment of clinical trials in CRPS, and outline the basic principles of rehabilitative treatment which is almost always needed. The overall aim is to improve diagnosis and treatment of CRPS worldwide.


8:30am EDT12:00pm EDT

Bedside: Demonstration of Variability in Clinical CRPS Presentation and Efforts to Develop Subgroups

Tracks: Chronic Pain: Other
Categories: Refresher Course

CRPS is characterized by a variety in clinical presentation. Both between patients and during the course of the disease within a patient. Traditionally, a distinction is made between CRPS1 and CRPS 2. Clinically, a distinction has also been made between warm and cold CRPS.

An increase in the understanding of the underlying pathophysiology makes it clear that different disease mechanisms may or may not play a role in the individual patient. Mechanisms involved are among others, auto inflammation, central sensitization and neuroplasticity with sensory, motor and autonomic disturbances, endothelial dysfunction and psychological factors. Clinical features aid in phenotyping. This creates the possibility to personalize the therapy. Prof. Huygen will provide guidelines on how to deal with this in daily clinical practice, based on current insights.

8:30am EDT12:00pm EDT

Bench: Recent Advances and Cutting-edge Approaches in our Understanding of the CRPS Pathophysiology

Tracks: Chronic Pain: Other
Categories: Refresher Course

In the last 2-3 years, the immune hypothesis in the development of CRPS has been strengthened. Prof. Birklein will talk about the most important work of his and other research groups on this topic. It could be shown that serum from CRPS patients is less or differently active in the degradation of inflammatory mediators and neuropeptides than serum from healthy individuals. Obviously, trauma seems to be responsible for this finding. It also fits that passive transfer of isolated IgM from patients with acute CRPS and isolated IgG from refractory patients with chronic CRPS sensitizes animals to pain when they have had prior trauma. These effects are mediated mainly by complement factors and cytokines in the spinal cord.

8:30am EDT12:00pm EDT

Return to Function: Evidence and Advances in Functional Rehabilitation

Tracks: Chronic Pain: Other
Categories: Refresher Course
Presented By: Dr. Jennifer S. Lewis

Interdisciplinary functional rehabilitation is acknowledged as the gold standard for the treatment of CRPS. A review of the current evidence will determine what constitutes functional rehabilitation and how effective it is in improving patients outcomes. Recent clinical outcome data will be presented to establish whether there are differences in clinical outcomes between early or persistent CRPS following specialist rehabilitation. The implications of these findings will be discussed in the context of informing future clinical practice. Finally, latest advances in rehabilitation treatment approaches will be discussed  


8:30am EDT12:00pm EDT

Summary of Current Therapies and an Outlook to Trials and Future Treatment Approaches

Tracks: Chronic Pain: Other
Categories: Refresher Course
Presented By: Dr. Andreas Goebel

Management of CRPS is directed by the patient’s clinical presentation and will almost always include rehabilitative approaches and medications; some patients may also benefit from interventional techniques including neuromodulation. No single drug treatment has achieved regulatory approval. Recent well-conducted drug trials were ‘negative’. Based on research advances, novel treatment technologies are emerging in the fields of prevention and rehabilitation, brain stimulation and neuromodulation, and immune drugs. Careful interpretation of efficacy trials for their relevance to clinical practice includes particularly an appreciation of the pertinent CRPS sub-groups.
This workshop-part aims to refresh our understanding of i) current treatment approaches for CRPS as directed by patient presentation, ii) treatments around the corner, ii) the interpretation of treatment-trial results.


Professor Frank Birklein

Head, Clinical Departement of Neurology Head, Pain Research and Treatment Center
Clinical Director; Head of the Peripheral Neurology and Pain Section

Dr. Andreas Goebel

Associate Professor
University of Liverpool

Professor Frank Huygen

The University Hospital Erasmus Medical Centre and University Medical Centre Utrecht

Dr. Jennifer S. Lewis

Associate Professor of Clinical Research and Senior Occupational Therapist
University of The West of England, Bristol