Complex Regional Pain Syndrome

What is Complex Regional Pain Syndrome?

Complex regional pain syndrome (CRPS) is a painful neurological and immunological disorder. For reasons not fully understood, the central (brain and spinal column) and peripheral (rest of the body) nervous systems in combination with our immune system malfunctions. The malfunction in these systems causes symptoms of Complex regional pain syndrome (CRPS) is a painful neurological and immunological disorder. For reasons not fully understood, the central (brain and spinal column) and peripheral (rest of the body) nervous systems in combination with our immune system malfunctions. pain, inflammation, skin discoloration, and skin temperature changes.

CRPS is a complex chronic pain disorder most often affecting one of the limbs (arms, legs, hand, or feet). CRPS has two categories:

  • CRPS I (previously known as reflex sympathetic disorder, RSD) which has no known nerve injury
  • CPRS II (previously known as causalgia) which is to have a known nerve injury

Typically, CRPS starts with a simple injury such as a scrape or sprain to one of the limbs. In some cases, the injury may be more severe or may occur after surgery, but not always. For unknown reasons, after an injury the nervous system sends protective signals to and from the brain; however, this signal is a misfire. In other words, the communication between the central and peripheral systems are overloaded by sending continuous messages of pain which are a protective mechanism of the body.

For whatever reason, the nervous system interprets the injury to be serious despite the injury having been long ago healed. In addition to the nervous system response, this condition triggers the immune system to kick in causing inflammation, redness, warmth, and swelling in the area.

What is typical for an immune system response to an injury, for unknown reasons becomes disruptive to the healing process. Just like with the misfire of the nervous system, the immune system stays hyperactive despite the injury being long ago healed.

Along with severe physical symptoms, people who suffer from CRPS also tend to have a psychological diagnosis, which is because the prolonged and constant severe pain, and in some cases the lack of proper diagnosis, can be emotionally draining. For many CRPS sufferers, they feel as though the medical community has failed them. Often misdiagnosed and misunderstood. The pain they feel is real despite all evidence proving the old injury is healed.

Anyone at any age can get CRPS; however, the most common age range is between 20-40 years old. CRPS does not affect children under the age of 10 and rarely in the elderly. For unknown reasons, this condition affects teenagers and women more so than any other group. Also, there is no evidence proving hereditary links to this condition.

An interdisciplinary approach is found to be more successful in managing CRPS. Due to the severe chronic pain of this condition, those who suffer from CRPS are at higher risk of abusing or even possibly becoming addicted to prescribed medications such as opioids.

An interdisciplinary approach between a chronic pain physician, psychologist, and a physical or occupational therapist is critical to managing the condition. Collectively, this team of professionals works together to teach those who suffer from this condition how to manage the symptoms and live a productive life.

What causes regional complex pain syndrome?

There is much to learned and understood about CRPS. There is no known reason why some with the same injury heal just fine while for others the condition turns into a chronic pain syndrome. Research has found some commonalities with CRPS, and they are:

  • Previous injury (e.g. fracture, burn, scrape, sprain, surgical site or immobilization of a limb)
  • Peripheral nerve abnormalities (the small nerve fibers are hyperactive)
  • Blood vessels are either over dilated (causing redness and swelling) or over constricted (causing white or bluish skin and cold limbs)
  • Immune system over produces cytokines (inflammatory chemical)

In rare cases of CRPS, there has been no known injury to the area. Researchers believe in these cases there was a possible internal injury such as an infection or entrapped nerve which may have been a triggering event.

Symptoms of Complex Regional Pain Syndrome

The most common symptom is prolonged, constant severe pain. Even though the injury may have been a small body part like a finger or toe, CRPS commonly spreads throughout the entire limb. In addition to severe pain, other symptoms may include:

  • Burning sensation
  • Discoloration (either redness or whitish/bluish in nature)
  • Hypersensitive to touch, tender
  • Joint stiffness, or loss of range of motion
  • Nail and hair growth changes (on the affected limb)
  • Pins and needles sensation
  • Poor muscle coordination of the limb
  • Profuse sweating of the limb
  • Sensation of squeezing pressure of the limb
  • Skin texture (e.g. shiny, thin, etc.)
  • Swelling
  • Tremors

How is complex regional pain syndrome diagnosed?

Diagnosing CRPS is difficult and should be taken with care with your health care provider. Often, CRPS can mimic other conditions such as polyneuropathy (Diabetes), arthritis, Lyme disease, a blood clot, or an infection. There are various qualified physicians that may diagnose CRPS; however, commonly by the time CRPS is suspected (everything else is ruled out) a neurologist is involved with the case. A neurologist specializes in managing conditions of both the central and peripheral nervous systems.

There is no specific test or tests to diagnose CRPS which is why it is not only a challenge to diagnose but can be very frustrating for those suffering from this condition. Most physicians begin to suspect CRPS when other medication conditions have been ruled out, and there has been a previous injury the affected limb. Through a thorough medical review and physical exam, the physician connects all the medical components to complete a differential diagnosis of CRPS.

Those who are preteens to early 20’s tend to have a full recovery when an interdisciplinary approach is used. For those who are older or whose symptoms are not caught early, symptoms can linger for years. Unfortunately, the more severe cases may have irreversible symptoms.

Treatment of Complex Regional Pain Syndrome

More research needs to be done on the effective treatment of CRPS; however, current research shows early intervention and treatment by an interdisciplinary team is successful. Conservative treatment by a physical or occupational (PT or OT) is important.

During treatment, your PT or OT will focus on:

  • Pain education-understanding the body and the science behind what causes pain has shown some success in managing pain with CRPS sufferers
  • Movement exercises-staying active is important in reversing the chemicals and neurological responses to and from the brain; learning how to stay active with low-impact exercise is good for pain management
  • Graded motor imagery (GMI)-even the smallest of movements can start to change the way the brain responds; another “rewiring” activity with GMI is called “mirror box imagery” the individual watches in a mirror the unaffected limb move as if their affect limb is moving

In addition to PT or OT, psychotherapist has also been found to be successful. CRPS is an extremely pain condition not only affecting the individual, but also those they love. Prolonged, chronic pain can cause depression, anxiety, and even post-traumatic stress disorder. Treatment of the secondary psychological symptoms is an important part of the healing process.

There are medications which help reduce the severity of symptoms. As with any medications, there can be serious side effects, so staying in close communication, and under close supervision, of a qualified physician is important. There are various medications your physician may consider when treating CRPS; a few may include:

  • Anti-inflammatory medications like prednisolone or methylprednisolone
  • Over-the-counter (OTC) medications like naproxen, aspirin, or ibuprofen
  • Opioids like oxycontin, morphine, fentanyl, and Vicodin
  • Topical creams or patches such as lidocaine

With CRPS, your physician will closely monitor your changing medical state as well as the side effects and risks of the prescribed medications.

Next Steps

Early diagnosis and intervention to CRPS are critical. The longer the syndrome goes undiagnosed or untreated, the higher the risk of permanency of symptoms. The sooner you address your symptoms, the more likely conservative care will work for you.

An interdisciplinary approach is critical for successfully managing CRPS. As a consumer of health care, you have a choice in finding the right provider for you. Do your homework and search for a health care provider, like a physical or occupational therapist, with excellent outcomes, great customer reviews, and can provide you the care you need for a reasonable cost.

Most states have direct access to a physical therapist, meaning you can go directly to a physical therapist without a physician order. To determine if your state has direct access, please visit the American Physical Therapy Association’s website Physical Therapy Direct Access By State.

To get started with conservative care today, you can find a highly qualified PT or OT in your area. There are many qualified PTs and OTs, so to find one near you, please click on Find A Clinic. This link will help you find a PT or OT that has top national rankings for treating chronic pain conditions like CRPS.

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