Complex Regional Pain Syndrome (CRPS)

Complex Regional Pain Syndrome (CRPS)

Dr. Kennedy
CRPS is a chronic pain condition that mainly affects the arms and legs. In most cases CRPS has three stages. Often, however, CRPS does not follow this pattern. Some people go into the later stages almost right away. Others stay in the first stage.

Stage 1 (typically lasts 1-3 months):

  • Severe burning, aching pain that increases with the slightest touch or breeze
  • Increased nail and hair growth
  • Pain that may move farther up or down the affected limb
  • Swelling with warmth or coolness
  • Skin that becomes dry and thin, changes color

Stage 2 (typically lasts 3-6 months):

  • Decreased hair growth
  • Noticeable changes in skin texture and color
  • Spread of swelling
  • Stiff muscles and joints

Stage 3 (irreversible changes can be seen)

  • Contractions involving muscles and tendons
  • Pain in the entire limb
  • Limited movement in limb
  • Muscle wasting
  • Depression or mood changes may occur with these symptoms, especially in stage 3.

Causes

There are two varieties of complex regional pain syndrome. CRPS 1 is a chronic nerve disorder that occurs most often in the arms or legs after a minor injury.
CRPS 2 is caused by an injury to the nerve. The cause of CRPS is not completely understood. It is thought to result from damage to the nervous system, including the nerves that control the blood vessels and sweat glands. The damaged nerves are no longer able to properly control blood flow, sensation, and temperature to the affected area. This leads to symptoms in all the structures innervated by the damaged nerve(s): blood vessels, bones, muscles, and skin. This condition is more common in people ages 40-60, but it has also been seen in younger people. Conditions that usually precede CRPS: injury or infection in an arm or leg, heart attack, and stroke. The condition can sometimes appear without obvious injury to the affected limb.

Diagnostic Testing

Diagnosing CRPS can be difficult, but early diagnosis is very important. Often, the symptoms are severe compared to the original injury. Tests may include:

  • A test to show temperature changes and lack of blood supply in the affected limb (thermography)
  • Bone scans
  • Nerve conduction studies
  • X-rays

Treatment

Treatment should be started as early as possible as this may prevent the disease from getting worse. Treatment usually includes a combination of therapies, such as:

  • Injected medicine that numbs the affected nerves or pain fibers around the spinal column (nerve block)
  • Spinal cord stimulator
  • Biofeedback
  • Heat and cold
  • Internal pain pump that directly delivers medications to the spinal cord
  • Medications – pain medicines, steroids, certain blood pressure medicines, bone loss medications, and antidepressants
  • Physical or occupational therapy
  • Surgery that cuts the nerves to destroy the pain (surgical sympathectomy)

Prognosis

The outlook is better with an early diagnosis. If the doctor diagnoses the condition within the first stage, sometimes signs of the disease may disappear and normal movement is possible. If the condition is not diagnosed quickly, changes to the bone and muscle may get worse be irreversible.

Prevention

Early treatment is the key to slowing the progression of the disease. There is no known prevention.

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