25 Feb Complex Regional Pain Syndrome
Complex regional pain syndrome is a disease that will generally initially affect the arms and legs. It is characterized by extreme pain and swelling in these areas, and will in most cases become worse over time. It will often fall under the broad specialty of doctors who deal with pain management. In virtually all cases, patients will report that the swelling and pain begins to spread to other parts of the body, and around 33% of patients will report that they feel the pain and swelling throughout their entire body. The actual syndrome has different types, commonly referred to simply as Type I and Type II. However, at its core, the syndrome is associated with a central nervous system that is not functioning properly.
Also referred to as Sudeck’s atrophy or reflex sympathetic dystrophy, this type of the complex regional pain syndrome does not show nerve lesions. Type I is the more common form of the syndrome and as a result most of the research into the disease has been focused on this type. Exact numbers are not currently known, however most researchers will agree that the vast majority of cases fall under this type of the syndrome.
The significant difference between this type and Type I is the nerve damage that occurs. Patients who suffer from Type II complex regional pain syndrome will usually have more painful occurrences. Unfortunately, this type of the syndrome is also more difficult to control using pain management.
The McGill pain scale can be used as a reference for the pain that is experienced with Type II of the syndrome. Patients will generally score between a 42 and a 50 when using the scale. The higher sense of pain that is felt is generally a result of the nerve damage that occurs throughout the body. It is considered to be on the most painful conditions that a patient can develop.
Physical and Psychological Factors
While the syndrome does not literally affect the psychological well being of patients, the extreme pain that is associated with it does often lead to psychological pain. This pain will lead to a decrease in the quality of the life of the patients. Unfortunately, the research into the area does not accurately reveal this and it is difficult to treat patients in these areas as a result. For more information regarding the psychological factors, see ‘A Review of Psychosocial Factors in Complex Regional Pain Syndrome’ – http://link.springer.com/article/10.1007%2Fs10880-012-9322-3
Luckily, there are options for those that are living with the syndrome. Rehabilitation therapy involves physical manipulation of the affected limbs and exercises that increase blood flow. Wide spectrums of medication options are available, although no drug is approved by the U.S. FDA for the specific treatment of CRPS. NSAIDS, opioids, corticosteroids, and topical anesthetic creams are all options. Intrathecal drug pumps can be used to administer drugs directly to the fluid around the spinal cord, the benefit being that much lower doses are required than other methods of administration.
A sympathetic nerve block involves injecting an anesthetic near the spine can reduce short-term pain. Long term studies have not been completed. Spinal cord stimulation involves implanting an electrode near the spine that causes a tingling sensation. This is typically first performed temporarily to assess whether the treatment is beneficial to the patient’s pain management. Other similar neural stimulation can be performed at other points in the pain pathway.
If it is detected at an early stage, treatment can be quite effective. If treatment is delayed, the syndrome can take over and cause pain and swelling throughout the body. However, even with treatment available, researchers have found that 77% of patients will have the syndrome spread to other parts of their body. If treated, the syndrome can go into remission; however there is always a high likelihood of the syndrome coming back. For this reason, it is important to work with a pain management Doctors in Orange County CA and to keep an eye on the condition.