Complex Regional Pain Syndrome (CRPS) is a chronic condition that causes a persistent, burning pain. Unlike most pain, the pain of CRPS doesn’t fade with time; instead, the pain is severe and continuous and tends to get worse over time. CRPS can occur after an injury, and is also referred to as Reflex Sympathetic Dystrophy (RSD).
What is Complex Regional Pain Syndrome?
People suffering with CRPS have skin that becomes so sensitive that even the slightest touch can cause excruciating pain. In addition to sensitivity, CRPS patients may experience swelling, sweating, and dramatic changes in skin color and temperature in the affected body part. Most commonly, CRPS affects hands, arms, feet, and legs. The affected body part may become stiff and difficult to move, and over time may remain in a fixed position.
There is no cure for CRPS, but remission is possible. The condition can occur in both young and old, with women being afflicted with CRPS more often than men.
What Causes Complex Regional Pain Syndrome?
The exact cause of CPRS isn’t clearly understood, and multiple causes are probable. Medical experts believe nerve damage is involved in most cases. Some cases of CPRS may occur because:
- Pain receptors become overly responsive to hormones in the body.
- There is an abnormal interaction with the body’s nervous systems.
- There is an inappropriate inflammatory response.
There are two types of CRPS, with similar signs and symptoms, but different causes:
Type 1 (also called Reflex Sympathetic Dystrophy Syndrome) occurs after an illness or injury that didn’t directly damage the nerves in the affected limb. This accounts for about 90% of the cases of CPRS.
Type 2 (once called Causalgia) occurs after a distinct nerve injury. Many cases of CPRS follow an event of forceful trauma to an arm or leg. This could be a crushing injury, a fracture, or even an amputation. Other times, CPRS can begin following:
- a heart attack
- an infection
- a sprained ankle
- emotional stress
There is not a clear understanding why any of these might trigger CPRS. However, in cases where CRPS is the result of an injury, the pain can be severe, even though the initial injury might have been minor. In many cases, CRPS is the result of multiple causes that act together to produce the various symptoms.
What Are the Symptoms of Complex Regional Pain Syndrome?
The primary symptom of CRPS is a prolonged pain that typically affects the upper and lower extremities (arms and legs). The pain may be constant and can be extremely uncomfortable, even severe. The pain may feel like a burning sensation. In some cases, the affected area may feel like it is being repeatedly stuck with “pins and needles.” Some patients report a sensation of the affected limb being squeezed. The pain may begin in a hand or foot, later spreading to the entire arm or leg. The pain may also travel to the opposite arm or leg.
CRPS-caused sensitivity can make the skin overreact to even the slightest sensation. This can result in pain from simple everyday occurrences like wind on the skin, or hand washing. Even touch and vibrations can cause excruciating pain.
The changes in skin temperature, color, and swelling result from abnormal circulation caused by damage to the nerves controlling blood flow and temperature. An affected arm or leg may feel warmer or cooler than the opposite limb. The affected area may become blotchy, blue, purple, pale, or red.
Other common symptoms of CRPS include:
- Skin texture can change and may appear shiny and thin.
- An abnormal sweating pattern in the affected area or surrounding areas.
- A slowing or increase in nail and hair growth.
- The affected joints may have stiffness.
- There may be coordination problems or a decreased ability to move an affected body part.
- Abnormal movement, tremors in, or jerking of, the affected limb.
- An abnormal and fixed limb posture.
How Is Complex Regional Pain Syndrome Diagnosed?
Currently, there is not a definitive diagnostic test to confirm CRPS. Instead, diagnosis is based on the affected individual’s medical history, and signs and symptoms that match the definition of CRPS. Several medical conditions can cause symptoms similar to CRPS, which makes a complete and early medical examination vital. Since many patients improve over time, early diagnosis is also important since it is difficult to diagnose once CRPS has spread beyond the initial area of pain.
CRPS is often associated with excess resorption of bone tissue, a process in which certain cells break down the bone and release calcium into the blood. For this reason, magnetic resonance imaging (MRI) or bone scans are used to help identify changes in the bone metabolism that may be CRPS-related.
Proper medical testing can help rule out other conditions, such as arthritis syndromes, Lyme disease, generalized muscle diseases, clotted veins, or small nerve disorders that may be the result of diabetes. Most of these conditions are not triggered by injury, and each requires a treatment different than CRPS.
How Is Complex Regional Pain Syndrome Treated?
Numerous therapies are used to treat Complex Regional Pain Syndrome, including spinal cord stimulation, physical therapy, and drug therapy.
Spinal Cord Stimulation: A device similar to a pacemaker, called a neurostimulator, is surgically implanted under the skin, typically in the abdomen or upper buttock, that delivers mild electrical impulses to an area near the spine. These impulses result in a mild tingling sensation rather than feeling the pain. Unlike most surgical procedures, spinal cord stimulation therapy is reversible. The device and all of its components can be removed with no permanent changes to the spine. Watch this video that explains spinal cord stimulation for chronic pain relief.
Targeted Drug Delivery: A drug pump is implanted under the skin in the abdomen. Because the drug pump releases medication directly to the source of pain, pain relief can be obtained with a small fraction of the oral medication dose. Watch this video that explains how targeted drug delivery works using a drug pump.
Physical Therapy: A specialized exercise program, designed to keep the painful limb or body part moving, can improve blood flow and lessen circulatory problems. Exercise helps improve the affected limb’s flexibility, strength, and function. Likewise, rehabilitation of the affected limb can help to prevent or reverse secondary brain changes that are often associated with chronic pain. Sometimes, occupational therapy also helps the patient learn new ways to work and perform daily tasks.
Medications: Several different medications have been effective in the treatment of CRPS, especially when treatment begins early. However, no drug is currently approved by the U.S. Food and Drug Administration (FDA) specifically for CRPS. It is important to note that no single drug, or combination of drugs, is guaranteed to be effective with every person.
Drugs used to treat CRPS include:
- Non-steroidal, anti-inflammatory drugs can be effective to treat moderate pain. These include over-the-counter aspirin, ibuprofen, and naproxen.
- Topical, local anesthetic creams and patches.
- Corticosteroids treat inflammation/swelling and edema.
- Drugs that treat seizures or depression have been shown effective for neuropathic pain.
- Botulinum toxin (Botox) injections may help in some cases.
- Various opioids.
Novus Spine & Pain Center
Novus Spine & Pain Center is in Lakeland, Florida, and specializes in treating Complex Regional Pain Syndrome. By using a comprehensive approach and cutting edge therapies, we work together with patients to restore function and regain an active lifestyle, while minimizing the need for opiates.
Complex Regional Pain Syndrome Resources
Reflex Sympathetic Dystrophy Syndrome Association (RSDSA)
P.O. Box 502
99 Cherry Street
Milford, CT 06460
Tel: 203-877-3790; 877-662-7737
Complex Regional Pain Syndrome Fact Sheet (Nat’l Institute of Health)
Complex Regional Pain Syndrome (Wikipedia)
Complex Regional Pain Syndrome (WebMD)
Complex Regional Pain Syndrome (Johns Hopkins Medicine)
Image credit: Wikipedia