Complex Regional Pain Syndrome
What is Complex Regional Pain Syndrome?
Complex regional pain syndrome (CRPS) isn’t clearly understood, but it is a form of chronic pain that usually affects an arm or a leg. CRPS usually develops after an injury, surgery, stroke or heart attack. The pain is often prolonged and out of proportion to the severity of the initial injury. CRPS can either be acute (recent, short-term) or chronic (lasting greater than six months).
CRPS is divided into two groups. The first, also called sympathetic dystrophy, develops without known nerve damage. The second, also called causalgia, occurs as a result of specific nerve damage. About 90% of cases are type 1.
While most cases of CRPS are mild and an individual recovers in a few months to a few years as the injured nerve regrows, symptoms can persist and long-term disability may result. If untreated, the disease can progress and atrophy (tissue wasting) and contracture (muscle tightening) can develop.
What are the Symptoms of Complex Regional Pain Syndrome?
Symptoms, can include:
- Continuous burning or throbbing pain, typically in an arm, leg, hand or foot (in some instances “mirror pain” may develop in a matching location on the opposite limb)
- Increased sensitivity to painful stimuli
- Feeling pain from stimuli that are not usually painful
- Sensitivity to touch or cold
- Numbness
- Joint stiffness, swelling and damage
- Muscle spasms, weakness, and tremors
- Decreased mobility in affected body part
- Swelling
- Changes in skin temperature, color, and texture
- Changes in hair and nail growth
Having CRPS is also associated with increased anxiety, depression and stress.
What Causes Complex Regional Pain Syndrome?
The exact cause of CRPS isn’t clearly understood, but it is thought to be caused by an injury to or a difference in the peripheral and central nervous system. In many causes, CRPS results after a trauma to an arm or a leg. The most common actions/activities that lead to CRPS include fractures, surgery, strains/sprains, limb immobilization (e.g., from being in cast), and lesser injuries such as burns or cuts.
Other influencing factors include poor circulation, poor nerve health, immune system involvement (for example, some individuals with CRPS have abnormal antibodies), and genetics.
How is Complex Regional Pain Syndrome Diagnosed?
There is no one test for CRPS, but the following are used in determining whether an individual may have CRPS:
- Physical exam
- Nerve conduction studies
- Ultrasound
- MRI
- Bone scans
- X-rays
- Sweat production tests
What is the Treatment for Complex Regional Pain Syndrome?
Treatments include:
- Medications (pain relievers, antidepressants and anticonvulsants, corticosteroids, bone-loss medications, synthetic nerve-block medications, intravenous ketamine, blood pressure lowering medications, topical analgesics)
- Heat therapy
- Physical or occupational therapy
- Biofeedback
- Acupuncture
- Mirror therapy
- TENS
- Spinal cord stimulation
- Intrathecal drug pumps
Outcomes for CRPS can vary widely, and early diagnosis and treatment is key. CRPS usually improves over time and goes into remission in most people; however, severe or prolonged cases can occur, and it recurs in about 10-30% of individuals.
Complex Regional Pain Syndrome can interfere with an individual’s ability to work or carry out daily tasks. If you have been diagnosed with CRPS and are worried that it may be impeding your ability to continue to safely practice on patients, you should speak with an experienced disability insurance attorney.
These posts are for informative purposes only and should not be used as a substitute for consultation with and diagnosis by a medical professional. If you are experiencing any of the symptoms described above and have yet to consult with a doctor, do not use this resource to self-diagnose. Please contact your doctor immediately and schedule an appointment to be evaluated for your symptoms.
Sources:
Mayo Clinic
National Institute of Neurological Disorders and Stroke
John Hopkins
Cleveland Clinic
Stanford
