Complex Regional Pain Syndrome
What is CRPS?
CRPS (Complex Regional Pain Syndrome), formerly known as RSD (Reflex Sympathetic Dystrophy), is a painful condition that usually develops when the area has suffered damage through an injury or trauma, such as fractures, sprains, strains, soft tissue injuries, muscular dystrophy, or even a common medical procedure. Although some pain is usual after an injury, CRPS is chronic pain of magnified intensity that persists after the injury should have healed.
What Causes CRPS?
While there are many possible explanations for the onset of this disorder, doctors still do not completely understand the cause of CRPS.
Research indicates that damage to or malfunction of the central and peripheral nervous systems may play a role. An individual with CRPS often has abnormalities in the peripheral nerves called “sympathetic nerves” which are nerves that normally send signals to the blood vessels, sweat glands and hair follicles. These abnormalities may affect the functioning of the blood vessels to the injured area leading to lower distribution of oxygen and nutrients, which may cause pain and damage under the skin or within the deepest part of the muscle. CRPS is also commonly associated with other inflammatory or autoimmune conditions such as asthma.
What is not clear is why only some individuals experience CRPS after certain injuries.
What are the Symptoms of CRPS?
The most significant symptom is prolonged, constant pain that is often severe. Though a previous injury may have only affected a small area such as a hand or foot, the entire limb may be extremely sensitive to touch. This pain with touch is called “allodynia”. The severe pain makes it difficult for the patient to move the affected area, which may lead to serious physical dysfunction and muscular atrophy from lack of using the muscles.
Symptoms indicative of CRPS aside from pain are more subtle and typically due to abnormal microcirculation within the limb.
Symptoms of CRPS include the following:
Affected limb is warmer or cooler than the other
Skin on affected limb might change to blotchy, blue, red, pale, or purple
Skin on affected limb may appear to change in texture, look shinier, or look thinner
Abnormal sweating in or around the affected area
Stiffness in joints
Limited mobility of the joint, difficulty with coordination of muscle movement
A fixed position of the limb, tremors or jerking
How is CRPS Treated?
There are a variety of treatments for CRPS, but the aim is always to given enough pain relief for the patient to be able to move and exercise the affected area.
Physical Therapy
This is the primary treatment modality for CRPS. If the patient has too much pain to participate in PT then pain relieving treatments as described next are implemented.
Injected anesthetics into or next to the spine block these nerves which are mentioned above. This can help to improve the circulation in the area and reduce pain, often immediately and dramatically lasting for days to weeks. If effective these injections are repeated as often as necessary to keep the pain and other symptoms under control and facilitate PT.
If less invasive treatments are not effective then wires can be placed near the spine and attached to a special programmer that stimulates the nerves to the painful area. This stimulation seems to override the pain giving the patient relief and it also tends to reduce the other symptoms such as swelling and skin discoloration as well. A trial is done where wires are inserted through a needle and if effective then the wires and programmer are surgically placed under the skin.
Many types of medications have proven useful in treating CRPS, mostly in the early stages of the disorder, though none have been officially designated specifically for CRPS or guarantee relief for every person.
