Authors: D’Souza RS et al.
Anesthesia & Analgesia. 141(6):1275–1285, December 2025.
Summary
This systematic review and meta-analysis quantified the global prevalence of complex regional pain syndrome (CRPS) among high-risk populations following an inciting event such as trauma or surgery. The authors analyzed 214 studies published between 1993 and 2023, encompassing 2,491,378 participants from 35 countries, of whom 16,873 developed CRPS. Using double–arcsine transformation and a random-effects model, the investigators pooled prevalence estimates at multiple time points.
The primary findings showed a pooled global prevalence of CRPS of 3.04% at 12 months and 6.46% at 24 months after injury or surgery. Secondary outcomes demonstrated measurable prevalence as early as 3 and 6 months, supporting the concept that CRPS often develops within the first year following an inciting event. Subgroup analyses revealed that CRPS prevalence was higher in patients with traumatic injuries alone compared with surgical injuries alone or combined traumatic/surgical mechanisms. Countries with high (but not very high) human development index (HDI) reported higher 12-month prevalence than those with medium or very high HDI, suggesting that socioeconomic and healthcare-system factors may influence diagnosis or reporting.
Methodological factors also played a role. Prospective studies reported higher prevalence than retrospective studies, and meta-regression identified publication year as a significant moderator, with more recent studies reporting lower 12-month prevalence. This temporal trend may reflect improved perioperative care, better fracture management, evolving diagnostic criteria, or earlier intervention. Overall, the study provides the most comprehensive benchmark to date for CRPS prevalence in at-risk populations worldwide.
Key Points
CRPS prevalence in high-risk populations is substantially higher than in the general population, reaching over 6% by 24 months after injury or surgery.
Traumatic injuries carry a higher risk of CRPS than surgical injuries alone.
Reported prevalence varies by socioeconomic context and study design, with prospective studies identifying more cases.
More recent publications show lower prevalence, suggesting changes in clinical practice, diagnosis, or prevention over time.
These benchmarks can help anesthesiologists and pain specialists focus surveillance and early intervention efforts on patients at greatest risk.
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