The following are the various signs and symptoms experienced by individuals affected by complex regional pain syndrome type II [8].

• Continuous throbbing pain in the affected limb, which may also be accompanied by burning sensation
• The affected area is sensitive to touch and cold
• Development of swelling in the affected area
• Significant changes in the nail and hair growth of the affected limb
• Skin can become tender and atrophic
• Stiffness in joint can set in, accompanied by development of swelling with consequent damage
• Reduced ability to move the affected joint
• Weakness and muscle spasms
• Change in color of the skin 
• Change in the temperature of the affected skin – skin can sometimes sweat or even turn cold

• Limb Pain

  […] and fibromyalgia as well as prosthesis training in patients with phantom limb pain and discrimination, mirror and imaginary training in patients with phantom limb pain and complex regional pain syndrome. de Treten bei komplexem regionalem Schmerzsyndrom [de.glosbe.com]

  Movement of this reflected normal limb is then performed so that it looks to the patient as though they are performing movement with the affected limb (although it will be pain free due to the fact it is a normal limb being reflected). [mipmpc.com]

  The mirror reflects the image of the unaffected limb and hides the affected (painful or missing) limb, giving patients the impression that they have two normal limbs. [msdmanuals.com]

  During this stage the symptoms include pain (usually described as a burning pain, which can be severe) and swelling, increased warmth in the affected part/limb, and excessive sweating. [davidlnelson.md]

• Movement Disorder

  The interactive session took place shortly after the society’s 11th biennial World Congress Berlin in June, where some 1,400 delegates addressed the full range of neuromodulation therapies for chronic pain, movement disorder, and emerging indications. [newswise.com]

  Video: 9 Minutes CLICK HERE Patients with such seemly bizarre movements might be inaccurately diagnosed with a psychogenic movement disorder. [rsdfoundation.org]

  The aching was exacerbated by local pressure or attempted foot movement. Over the next month the symptoms steadily worsened to the point of an inability to bear any weight on the right foot. [archivesofrheumatology.org]

  Schwartzman RJ et al: The movement disorder of reflex sympathetic dystrophy. Neurology; 40:57-61, 1990. 8. Howard SA et al: Reflex sympathetic dystrophy and cigarette smoking. J Hand Surg Am; 13A: 470-472, 1988 9. [ispub.com]

• Arm Pain

  Three months after, he presented to an outpatient pain management clinic right arm pain and was diagnosed with complex regional pain syndrome type II (CRPS II). [ncbi.nlm.nih.gov]

  Thinking about movement hurts: The effect of motor imagery on pain and swelling in people with chronic arm pain. [bodyinmind.org]

• Hand Pain

  Two patients received mirror therapy with the painful hand hidden behind the mirror while the non-painful hand was positioned so that, from the perspective of the patient, the reflection of this hand was "superimposed" on the painful hand. [ncbi.nlm.nih.gov]

• Tachycardia

  […] encephalopathy brainstem ischaemia causing nystagmus and other ocular effects, tremors and ataxia, mental confusion, hypothermia and hypotension; more common in chronic alcoholics Wolff–Parkinson–White syndrome congenital atrioventricular interconnection causing tachycardia [medical-dictionary.thefreedictionary.com]

• Skin Discoloration

  He suggested that SCS probably has a dual effect in CRPS by addressing neuropathic pain as well as helping normalize aberrant microcirculation that is associated with swelling, skin discoloration, temperature changes and related complaints. [newswise.com]

  For definitions of terms, refer to Merskey and Bogduk. 31 × Vasomotor changes cause diverse skin discoloration, including various hues of red and purple to mottled, ashen, and gray. [anesthesiology.pubs.asahq.org]

• Shoulder Pain

  "Shoulder pain in hemiplegia". Physical Medicine and Rehabilitation Clinics of North America. 15 (3): vi–vii, 683–97. doi : 10.1016/S1047-9651(03)00130-X. PMID 15219895. ^ Pawelka S, Fialka V, Ernst E (January 1993). [en.wikipedia.org]

• Muscular Atrophy

  Duchenne's muscular dystrophy ( Duchenne type muscular dystrophy ) The childhood type of muscular dystrophy. myotonic dystrophy a rare, slowly progressive, hereditary disease, marked by myotonia followed by muscular atrophy (especially of the face and [medical-dictionary.thefreedictionary.com]

• Hyperalgesia

  In hyperalgesia, a normally painful stimulus causes much more irritation and pain than would be typically produced. [lapaindoc.com]

  Complex regional pain syndrome (CRPS) is a well-known clinical entity, first described in the 1800s, consisting of pain, hyperalgesia, edema, and sudomotor changes either without (Type I) or with (Type II) a definable nerve injury. [ncbi.nlm.nih.gov]

  The presence of continuing pain, allodynia, or hyperalgesia after a nerve injury, not necessarily limited to the distribution of the injured nerve. 2. [medlink.com]

  Hyperalgesia is when a normally painful stimulus becomes much more painful than would normally occur. These are thought to involve both the central nervous system (CNS) and the peripheral nervous system (PNS). [omegapainclinic.com]

• Neuralgia

  The vast majority of shingles/ postherpetic neuralgia cases occur in the torso and face without CRPS phenomena; therefore, in shingles/ postherpetic neuralgia of a limb, specific distal microvascular anatomy and gravity are likely to play a role in the [medlink.com]

  The topography of symptoms could have indicated neuralgia of a terminal branch of the trigeminal nerve; however, as symptoms progressed, sensory alterations involved not only the inferior alveolar nerve but also the territories innervated by the lingual [elsevier.es]

  A recent study showed that, at least for diabetic neuropathy and post-herpetic neuralgia, the combination of gabapentin and morphine was more effective than either agent alone [12]. [academic.oup.com]

  Four years of treatment with ketamine and a trial of dextrometorphan in a patient with severe post-herpetic neuralgia. Acta Anesthesiol Scand 41:422-426, 1997. Nikolajsen L et al. Oral ketamine therapy in the treatment of postamputation stump pain. [siicsalud.com]

  Both intravenous lidocaine and morphine reduce the pain of postherpetic neuralgia. Neurology. 1991;41(7):1024–8. CrossRef PubMed Google Scholar 12. Mellick GA, Mellicy LB, Mellick LB. Gabapentin in the management of reflex sympathetic dystrophy. [link.springer.com]

• Headache

  Use of cluster analysis to validate IHS diagnostic criteria for migraine and tension-type headache. Headache 1999; 39: 181-189. 8. Merikangas KR, Frances A. Development of diagnostic criteria for headache syndromes: lessons from psychiatry. [bmj.com]

  Curr Pain Headache Rep., 2001. (level of evidence 2A) ↑ BARON, R., Complex regional pain syndromes. Curr Pain Headache Rep., 2001. [physio-pedia.com]

  Descriptive symptom-based consensus criteria were deemed acceptable because of successful similar efforts in the fields of headache and psychiatry, where pathophysiologically-based diagnostic criteria were also inadequate. [medlink.com]

  77–83Oerlemans, HM Oostendorp, RA de Boo, T Goris, RJ Morley S, Eccleston C, Williams A: Systematic review and meta-analysis of randomized controlled trials of cognitive behaviour therapy and behaviour therapy for chronic pain in adults, excluding headache [anesthesiology.pubs.asahq.org]

  […] sympathetic pain syndrome persistent and severe skin paraesthesia/burning sensations; caused by trauma to peripheral sensory nerve fibres; symptoms, progress and treatment are similar to that of CRPS 1 Conn's syndrome primary aldosteronism; characterized by headaches [medical-dictionary.thefreedictionary.com]

• Dysautonomia

  Bruehl’s comment should assist physicians with the differential diagnosis and evaluation of patients with painful peripheral neuropathy/dysautonomia (PPND). These address physical issues only. [bmj.com]

  These studies determined that sensitivity of the criteria was high (0.98), but specificity was poor (0.36); there was a tendency to over-diagnosis; a positive diagnosis could be correct in as few as 40% of cases; and the criteria for dysautonomia were [medlink.com]

  […] related pain (acute) (chronic) G89.4 Chronic pain syndrome G90 Disorders of autonomic nervous system G90.0 Idiopathic peripheral autonomic neuropathy G90.01 Carotid sinus syncope G90.09 Other idiopathic peripheral autonomic neuropathy G90.1 Familial dysautonomia [icd10data.com]

  […] be triggered by accumulation of metabolites and uraemia Reye's syndrome cerebral oedema and death (in 50% of cases, usually children), provoked by aspirin therapy; aspirin is proscribed for children less than 16 years old Riley–Day syndrome; familial dysautonomia [medical-dictionary.thefreedictionary.com]

• Paresthesia

  During MCS, a subjective sensation of warm paresthesia developed in the painful hand and forearm and spread toward the trunk. Pain and allodynia in the areas associated with this sensation were alleviated significantly. [ncbi.nlm.nih.gov]

  SCS replaces the area of intense pain with a more pleasant tingling sensation called paresthesia. 39-42 The tingling sensation will remain relatively constant and should not hurt. [rsdfoundation.org]

A preliminary physical examination, coupled with past medical history would be taken initially. This would be followed by several diagnostic methods to accurately judge the condition.

• Bone scan: Such a kind of procedure helps in detection of changes in the bone.
• Tests for sympathetic nervous system: In this, various tests are employed for detecting the functioning of sympathetic nervous system. These tests include measuring the temperature of the affected skin and blood flow through thermography. In addition, the amount of sweat produced in both the limbs would also be done. If there is significant difference in the amount of sweat production, it suggests development of complex regional pain syndrome.
• Imaging studies: MRI would be carried out, which would provide insight about the changes that have taken place in the tissues. X-rays of the bone should also be done which would reveal mineral density of the bone [9].

If treatment is initiated within first few months of onset of symptoms, then the condition can be effectively managed with medications and therapies. The following methods are administered for treatment of complex regional pain syndrome type II.

Medications

Various pain relieving medications are employed for helping the patients deal with pain. Other class of medications to manage other symptoms is also employed. These include anticonvulsants, corticosteroids, intravenous ketamine and sympathetic nerve blocking medications. Research has shown tha, ketamine given intravenously helps in relieving the pain [10].

Therapies

Various types of therapies that involve physical therapy, biofeedback and transcutaneous electrical nerve stimulation are beneficial. In addition to these, analgesics to be applied on the area are also provided. A new mode of therapy has been introduced known as the spinal cord stimulation therapy. In this, tiny electrodes are inserted along the spinal cord in order to provide relief [11].

If treatment has been initiated within 3 months of first appearance of the signs and symptoms then a good prognosis can be expected. However, if there is delay in initiation of treatment, the disease can rapidly affect the entire limb causing irreversible damage to the bones, nerves and muscles. In addition, affected individuals can suffer from atrophy of muscles and in many cases, limb amputation may be required [7].

Complex regional pain syndrome type II majorly occurs due to nerve injury that can results from various factors. These include crush injuries, surgery, forceful trauma to the arm and leg, heart attack, sprained ankle and infections. In many cases, emotional stress also significantly participates in the development of complex regional pain syndrome type II. All these factors are known to cause injury to the nerve of the peripheral nervous system [3].

The incidence of complex regional pain syndrome type II has been calculated to be 0.8 per 100,000 individuals. The prevalence of the condition is estimated to strike every 4 individuals per 100,000. Statistics have also revealed that, after peripheral nerve injury, the incidence of complex regional pain syndrome II occurs in 1 – 5% of cases [4] [5]. Females are more prone to develop the disease condition than males.

The exact pathophysiology of complex regional pain syndrome type II is not completely understood. Scientists believe that sensitization of the peripheral and central nerves that occur due to response to tissue injury give rise to the severe pain in the affected arm or leg.

Sensitization of the central nervous system and increase in pain gradually are some of the key points in the onset of complex regional pain syndrome. In addition to this, there is significant evidence of involvement of N-methy-D-aspartate in the sensitization process of the central nervous system. Such sequence of events leads to development of mechanical hyperalgesia, which is characterized by severe pain in the affected limb [6].

Various steps can be taken for preventing the development of complex regional pain syndrome. Individuals who have suffered wrist fracture are advised to take vitamin C supplements in order to prevent developing the syndrome later in life. It is also necessary that patients who have suffered at attack of stroke should practice early mobilization.

Complex regional pain syndrome type II in the past was also known as causalgia [1]. Significant trauma to a nerve of the peripheral nervous system gives rise to severe pain along with burning sensation in the affected arm or leg. It is a chronic disease condition, which gradually gets more severe as the disease progresses. So far, there is no known cure to the condition; it can however be managed with medications [2].

• Definition: Complex regional pain syndrome type II, is characterized by onset of pain in an arm or leg due to injury to the nerve. The condition is more common in females than males.
• Cause: Injuries, stroke, heart attack, sprained ankle and minor injuries can favor distinct nerve injury causing development of complex regional pain syndrome.
• Symptoms: Some of the common symptoms include pain in the affected limb along with burning sensation. The affected area may also undergo change in color as well as temperature. In addition, there is joint stiffness, muscle spasms, and reduced ability to move the part that is affected.
• Diagnosis: Physical examination, radiographs, MRI and bone scan are employed for diagnosing the condition.
• Treatment: Affected individuals are given medications and various therapies for relieving the pain and management of other symptoms. Neurostimulation of the spinal cord is also done for relieving the intense pain.

• Bonica JJ. Causalgia and other reflex sympathetic dystrophies. Postgrad Med 1973; 53:143.
• Harden RN, Bruehl S, Galer BS, et al. Complex regional pain syndrome: are the IASP diagnostic criteria valid and sufficiently comprehensive?. Pain. Nov 1999;83(2):211-9.
• Schinkel C, Gaertner A, Zaspel J, et al. Inflammatory mediators are altered in the acute phase of posttraumatic complex regional pain syndrome. Clin J Pain 2006; 22:235.
• Allen G, Galer BS, Schwartz L. Epidemiology of complex regional pain syndrome: a retrospective chart review of 134 patients. Pain. Apr 1999;80(3):539-44
• Baron R, Binder A. Pappagallo M (ed). Complex regional pain syndromes, in The neurological basis of pain. New York: McGraw-Hill; 2005:359-378.
• Baron R, Wasner G, Borgestedt R, et al. Effects of sympathetic activity on capsaicin-evoked pain, hyperalgesia and vasodilation Neurology. 1999;52:923-932.
• Pleger B, Tegenthoff M, Ragert P, et al. Sensorimotor retuning [corrected] in complex regional pain syndrome parallels pain reduction. Ann Neurol 2005; 57:425.
• Janig W, Baron R. Complex regional pain syndrome is a disease of the central nervous system. Clin Auton Res. Jun 2002;12(3):150-64
• Todorovic-Tirnanic M, Obradovic V, Han R, Goldner B, Stankovic D, Sekulic D. Diagnostic approach to reflex sympathetic dystrophy after fracture: radiography or bone scintigraphy?. Eur J Nucl Med. Oct 1995;22(10):1187-93.
• Christensen K, Jensen EM, Noer I. The reflex dystrophy syndrome response to treatment with systemic corticosteroids. Acta Chir Scand. 1982;148(8):653-5. 
• Davis KD, Treede RD, Raja SN, Meyer RA, Campbell JN. Topical application of clonidine relieves hyperalgesia in patients with sympathetically maintained pain. Pain. Dec 1991;47(3):309-17