December 20, 2025

@michaelokun

Can pain rewrite or rewire the nervous system? A new review just dropped in NEJM on Complex Regional Pain Syndrome. 'Nociplastic' is a term that describes pain driven by abnormal nerve signaling and brain processing, rather than by ongoing tissue damage or a single injured nerve. Andreas Goebel and colleagues describe complex regional pain syndrome and walk us through how this condition emerges after injury or surgery, and how it should be recognized and managed. Key points: - CRPS is a rare post trauma pain condition where pain is severe and persistent even when scans and tests appear largely normal. - Most folks improve substantially within about 18 months, however a subset develop persistent symptoms that are disabling. - Education plus CRPS specific rehabilitation form the backbone of care, while medications and procedures provide partial relief for some folks. My take: Complex regional pain is one of the most challenging disorders to diagnose and treat. This article did not really cover the associated movement disorders. Movement disorders can be part of CRPS. When they occur, as many as half or more have been labelled as functional. Fixed dystonia and tremor are the ones commonly encountered by movement specialists. Here are 5 points that resonated w/ me about this fantastic article: 1- CRPS pain seems to come from sensitized nerves and brain circuits, not from damage that keeps getting worse. 2- Early recognition matters because gentle movement and the right kind of therapy may possibly calm pain pathways. 3- Standard pain pills frequently help only a little, and strong opioids commonly create more harm than benefit. 4- Physical and occupational therapy for CRPS is different. It is typically gentle and focused on retraining the brain and limb. 5- If pain lasts beyond 18 months, specialized pain programs and neuromodulation (spinal cord DBS) may help some folks. https://www.nejm.org/doi/abs/10.1056/NEJMcp2415752 #pain #michaelokun #nejm #fixelinstitute