Complex regional pain syndrome
What is complex regional pain syndrome?
Complex regional pain syndrome (CRPS), formerly known as Reflex Sympathetic Dystrophy (RSD), is a chronic pain and sensory condition that typically affects the upper and lower extremities (arms and legs). Women are more likely to be affected than men and the disease is most common between the ages of 40-60.
What causes complex regional pain syndrome?
There are two types of complex regional pain syndrome – Type 1 and Type 2 – which have similar symptoms, but different causes.
Also known as reflex sympathetic dystrophy syndrome, this type occurs after an illness or injury that didn’t directly damage the nerves in your affected limb. About 90% of people with complex regional pain syndrome have type 1.
Once referred to as causalgia, this type follows a distinct nerve injury. Many cases of complex regional pain syndrome occur after a forceful trauma to an arm or a leg, such as a crush injury, fracture, or amputation. Other major and minor traumas — such as surgery, heart attacks, infections, and even sprained ankles — also can lead to complex regional pain syndrome. Emotional stress may be a precipitating factor, as well.
Your physician may perform a physical examination demonstrating tenderness over certain areas as well as assessing limitations in movement. The doctor will evaluate the extent of your restricted movements, the amount of pain produced, and your sensory function. Your physician may also order radiological imaging such as X-ray, CT scan, MRI, or bone scan.
Signs and symptoms of complex regional pain syndrome include:
- Continuous burning or throbbing pain, usually in your arm, leg, hand or foot
- Sensitivity to touch or cold
- Swelling of the painful area
- Changes in skin temperature — at times your skin may be sweaty; at other times it may be cold
- Changes in skin color, which can range from white and mottled to red or blue
- Changes in skin texture, which may become tender, thin or shiny in the affected area
- Changes in hair and nail growth
- Joint stiffness, swelling and damage
- Muscle spasms, weakness and loss (atrophy)
- Decreased ability to move the affected body part
- Physical therapy: In order to decrease or prevent functional limitations, physical therapy and occupational therapy are recommended as well as medical treatments. Physical therapy focuses on exercising the affected limbs, improving range of motion and strength.
- Biofeedback: Patients learn to have a better awareness and familiarity with their body. As they learn to relax their body, pain relief is obtained. The psychological component of treatment can work with medical therapies to improve function and decrease the severity of the disease.
- Sympathetic Nerve Blocks: The procedure involves inserting a small, fine needle through the skin to the origins of the sympathetic nervous system. When the nerves are blocked, pain relief can be dramatic for some individuals. Procedures that focus on the face and upper extremities include the stellate ganglion block and brachial plexus nerve block. Lumbar sympathetic nerve blocks are commonly performed for CRPS in the lower extremities.
- Spinal Cord Stimulation: This method involves tiny electrodes being placed within the epidural space close to the spinal cord. The electrodes release a small electrical current to the spinal cord that inhibits pain transmission, thereby providing pain relief.
- Peripheral Nerve Stimulation: This method involves tiny electrodes being placed close to the affected nerves. The electrodes release a small electrical current that inhibits pain transmission and provides pain relief.
Pharmacological treatments for management of CRPS can be membrane stabilizing drugs, NSAIDs, or opiate-like medications.