Complex Regional Pain Syndrome (CRPS)
Complex Regional Pain Syndrome (CRPS), formerly referred to as Reflex Sympathetic Dystrophy or RSD, is a rare disorder that causes spontaneous and disproportionately intense pain in response to a sensory stimulus. For example, a light touch of skin which is otherwise painless can cause extreme and lasting pain in patients with CRPS. The condition develops after an incidence of trauma or other medical conditions and usually affects one of the limbs. Though an exact etiology of the condition is unknown, early detection is important to manage its symptoms and progression.
What Is Complex Regional Pain Syndrome (CRPS)?
This condition is subdivided into two categories: type I and type II CRPS. Type I CRPS comprises about 90% of all CRPS cases and is associated with no identifiable nerve injuries or lesions.
CRPS type II or causalgia, on the other hand, is when there is evidence of nerve damage. Although it can occur in anyone at any age, CRPS is more common in women but rare in elderly and children under 10 years of age.
The key symptoms of CRPS are prolonged and severe pain. The pain is often deep and has been described as “burning,” “stinging,” or “tearing” sensation. The pain may spread to the entire affected extremity, or in rare cases, may travel to the opposite extremity as well. Along with the pain, some patient also experiences symptoms like:
- Change in the skin color, temperature, and texture on the affected area, the skin might appear red/blue, shiny, and thin
- Sweating around the affected area
- Changes in nail and hair growth
- Joint stiffness
- A decrease in the ability to use the affected limb for movement
- Muscle spasms
Mostly, these symptoms begin at the site of the condition but may spread to other regions as CRPS progresses. Also, the symptoms vary in severity and duration. Mild cases are easier to treat and eventually go away. In case of severe symptoms, early treatment is helpful in limiting the disorder and preventing long-term disability.
What Causes CRPS?
While the exact cause of the condition is unclear, multiple factors likely contribute to its development.
The most common trigger factors include fractures, sprains/strains, burns or other soft tissue injuries, limb immobilization, surgery, or even minor medical procedures. CRPS is caused by an abnormality in the response of the sympathetic nervous system to a trigger that causes no symptoms for other people.
Limited data suggest that genetics might play a role in the development of the condition. Familial CRPS has an early onset, is more severe, and often affects more than one limb.
How Is CRPS Diagnosed?
Diagnosis of complex regional pain syndrome is difficult as there is no specific test to confirm the diagnosis. The diagnosis is framed based on a person’s medical history, physical examination, and signs/symptoms.
Blood testing, magnetic resonance imaging, and bone scans might help to confirm the diagnosis and rule out conditions like rheumatoid arthritis, Lyme disease, clotted veins, etc.
How Is This Condition Treated?
CRPS is a complex condition with no set treatment plan to manage it. Hence, it is treated using different approaches like physical therapy, occupational therapy, and medications. The goal of treatment is to manage the pain and increase the mobility of the affected limbs.
Physical and occupational therapy are considered first-line treatments for CRPS. Physical therapies improve blood flow, flexibility, strength, and function of the affected limbs to prevent or reverse the secondary brain changes that are associated with chronic pain. These methods also train the brain to enhance motor coordination and functioning of the limbs.
Some of the conservative and minimally-invasive treatment options are:
- Physical Therapy – Desensitization, strength and flexibility training
- Medications – Medications are effective when used early during the disease. Drugs like bisphosphonates, non-steroidal anti-inflammatory drugs, corticosteroids, and opioids such as oxycodone and morphine can be used alone or in combination to improve the symptoms.
Interventional Pain Management Approach
The experts at MidSouth Pain Treatment Center are equipped to help you manage your pain using interventional pain management procedures such as:
1. Sympathetic Nerve Block
This involves injecting an anesthetic into the spine to block the activity of the sympathetic nerve flow and offer temporary pain relief.
2. Dorsal Root Ganglion Stimulation
By targeting the nerves directly, a Dorsal Root Ganglion Stimulation procedure acts similarly to a nerve block to dull or lessen the pain from CRPS.
3. Spinal Cord Stimulation (SCS)
This procedure involves placing stimulating electrodes into the spine through a needle to mask the pain signals before they reach the brain. Once implanted, the patient can control the stimulator and adjust it using an external controller.
If you suffer from pain, especially chronic pain, schedule an appointment with us. Our team of doctors will work together with you to design a comprehensive treatment plan to help you live a pain-free life.