Complex regional pain syndrome (CRPS), also known as reflex sympathetic dystrophy (RSD) is a type of chronic pain which regularly affects a leg or an arm, and develops after a stroke, heart attack or surgery. Its most distinctive characteristic is pain disproportionate to the pain of the initial injury.
What are the common symptoms of complex regional pain syndrome?
Complex regional pain syndrome has many symptoms and signs. You may become aware of:
sensitivity to cold and touch
continuous throbbing or burning, most often in the foot, leg or arm
skin temperature changes: sometimes sweaty and other times cold
skin color changes: from white or mottled to blue or red
skin texture changes: becoming thin, tender, or shiny
changes in nail and hair growth
joint swelling, stiffness and damage
muscle weakness, spasms or atrophy (the wasting away of muscle mass)
diminished ability to move the painful area
It is possible for these symptoms to change over time or to vary from one individual to the next. Your pain may start in one place, and then migrate to another part of your body, for example from one foot to the other. Also, you may realize that your pain intensifies in stressful situations.
What is the cause of CRPS?
There are two types of complex regional pain syndrome. Although they have similar Complex Regional Pain Syndrome (CRPS)symptoms and signs, they’re attributed to distinctly different causes. Type 1, once called sympathetic dystrophy syndrome,
occurs after an injury or illness that did not inflict damage directly the nerves of the affected limb. Nearly 90% of complex regional pain syndrome patients have Type I. In contrast, Type 2, formerly called causalgia, occurs immediately after an injury to specific nerves. Very often, an episode of complex regional pain syndrome follows extreme trauma to a leg or arm, e.g., car crash injuries, amputation, or fractures. Other kinds of traumas, including heart attacks, surgery, infections or even something as seemingly insignificant as a sprained ankle, can bring on complex regional pain syndrome. Persistent stress is also recognized as a contributing factor.
While we do not fully understood how these injuries managed to trigger complex regional pain syndrome, researchers believe it may be the result of a dysfunctional interaction between your peripheral nervous system and your central nervous system, coupled with misguided inflammatory reactions.
What are the complications of CRPS?
When complex regional pain syndrome is not diagnosed correctly or in not treated early on, patients may develop more extreme symptoms and signs. These might include: muscle, bone and skin tissue deterioration because the patient intentionally limits moving the affected limb to avoid pain; and tightening muscles that may result in your foot and toes or hand and fingers freezing in a cramped position.
When should I see a doctor if I believe I may have CRPS?
If you have severe, constant pain in one of your limbs, if moving or touching limb is almost unbearable, you should see your doctor immediately to identify its cause. Remember: for treatment to be successful, it must begin as soon as possible.
How is complex CRPS diagnosed?
An accurate diagnosis of your complex regional pain syndrome will be based on the results of a physical exam and your medical history. No one test can be relied upon exclusively to diagnose complex regional pain syndrome, but there are several procedures used to uncover significant clues. These include:
testing your sympathetic nervous system to measure skin temperature, blood flow, sweat production, and other physical characteristics
bone scans to detect changes in your bones
x-rays to assess mineral loss from your bones
magnetic resonance imaging (MRI) to reveal changes in your tissue
How is CRPS treated?
Complex Regional Pain Syndrome (CRPS) (2)For some fortunate patients, symptoms and signs tend to diminish and disappear without treatment. However, when treatment is called for, start as soon as possible after the symptoms emerge; this swift response is often highly successful, counteracting symptoms and, on occasion, even resulting in remission.
Doctors often prescribe a variety of medications to treat complex regional pain syndrome symptoms. These include:
over-the-counter pain medications like aspirin and ibuprofen or prescription medications such as Celebrex
medications to stall or prevent bone loss
steroid prescriptions to improve mobility and inhibit inflammation
anticonvulsants and antidepressants to counter the pain of nerve damage
medications to block sympathetic nerves and provide some relief from pain
Several therapeutic treatments may provide some relief; these include: topical analgesics, hot or cold packs, physical therapy, biofeedback, transcutaneous electrical nerve stimulation and spinal cord stimulation. On occasion complex regional pain syndrome may reoccur following exposure to cold or extreme emotional stress.