The aetiology of complex regional pain syndrome is uncertain. The most widely accepted theory proposes the existence of an abnormal reflex arc within the sympathetic nervous system. Following trauma there is a transient alteration in the vasomotor tone of the affected region - unduly sustained changes may result in permanent disturbance of the microcirculation. Local tissue ischaemia leads to acidosis and tissue dystrophy. The acid metabolites may then activate osteoclasts resulting in local osteoporosis.
The pathogenesis either does or does not have an inciting event - see the classification section.
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