What is complex regional pain syndrome (CRPS)?
Complex regional pain syndrome is pain that may occur after an injury to an arm or a leg. In rare cases, the syndrome develops after surgery, a heart attack, a stroke or other medical problem. The pain is often described as a burning feeling and is much worse than expected for the injury. Your doctor may also call this condition reflex sympathetic dystrophy or causalgia. The cause of the syndrome is not known.
Symptoms include -
- "Burning" pain in your arm, leg, hand or foot.
- Skin sensitivity.
- Changes in skin temperature, color and texture. At times your skin may be sweaty; at other times it may be cold. Skin color can range from white and mottled to red or blue. Skin 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.
Symptoms may change over time and vary from person to person. Most commonly, swelling, redness, noticeable changes in temperature and hypersensitivity (particularly to cold and touch) occur first. Over time, the affected limb can become cold and pale and undergo skin and nail changes as well as muscle spasms and tightening. Once these changes occur, the condition is often irreversible. CRPS can be Type I (RSD) occurs after an illness or injury that didn't directly damage the nerves in your affected limb Or Type II (Causalgia) - this type follows a distinct nerve injury.
If you experience constant, severe pain that affects a limb and makes touching or moving that limb seem intolerable, see your doctor to determine the cause. It's important to treat complex regional pain syndrome early.
If complex regional pain syndrome isn't diagnosed and treated at an early stage, the disease may progress to more disabling signs and symptoms. These may include: Muscle wasting (atrophy), Contracture. Complex regional pain syndrome occasionally may spread from its source to elsewhere in your body in these patterns: Continuity type. The symptoms may migrate from the initial site of the pain — for example, from your hand to your shoulder, trunk and face. Mirror-image type. The symptoms may spread from one limb to the opposite limb. Independent type. Sometimes, the symptoms may leap to a distant part of your body.
Diagnosis - based on a physical exam and your medical history. The following procedures can help in reaching the diagnosis
- Bone scan.
- Sympathetic nervous system tests. These tests look for disturbances in your sympathetic nervous system. For example, thermography measures the skin temperature and blood flow of your affected and unaffected limbs. Other tests can measure the amount of sweat on both limbs. Dissimilar results can indicate complex regional pain syndrome.
- X-rays. Loss of minerals from your bones may show up on an X-ray in later stages of the disease.
- Magnetic resonance imaging (MRI). Images captured by an MRI device may show a number of tissue changes.
- Sympathetic nerve diagnostic block
Dramatic improvement and even remission of complex regional pain syndrome is possible if treatment begins within a few months of your first symptoms. Often, a combination of various therapies is necessary. Your doctor will tailor your treatment based on your specific case. Treatment options include:
Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen and naproxen sodium may ease pain and inflammation. In some cases, antidepressants, such as amitriptyline, and anticonvulsants, such as gabapentin (Neurontin), are used to treat pain that originates from a damaged nerve (neuropathic pain). Corticosteroids, such as prednisone, may reduce inflammation. Your doctor may suggest bone-loss medications, such as alendronate and calcitonin. Opioid medications may be another option. Taken in appropriate doses, they may provide acceptable control of pain.
- Applying heat and cold
- Topical analgesics may reduce hypersensitivity, such as lidocaine or a combination of ketamine, clonidine and amitriptyline.
- Physical therapy. Gentle, guided exercising of the affected limbs may improve range of motion and strength. The earlier the disease is diagnosed, the more effective exercises may be.
- Sympathetic nerve-blocking medication
- Transcutaneous electrical nerve stimulation (TENS). Chronic pain is sometimes eased by applying electrical impulses to nerve endings.
- Biofeedback. In some cases, learning biofeedback techniques may help. In biofeedback, you learn to become more aware of your body so that you can relax your body and relieve pain.
- Spinal cord stimulation