Complex Regional Pain Syndrome

Definition

Complex regional pain syndrome (CRPS) refers to a chronic condition that affects the nerves and blood vessels of one or more limbs.

There are two types of CRPS:

  • CRPS 1, previously called reflex sympathetic dystrophy or RSD, has no observable nerve damage.
  • CRPS 2, previously called causalgia, produces similar symptoms after a verified nerve injury has occurred.
Complex Regional Pain Syndrome
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Causes

The cause of CRPS is not known. The condition likely results from several factors. It may involve overactivity of the sympathetic nervous system. Inflammation may also play a role in the disorder.

Risk Factors

Factors that may increase your risk of CRPS include:

  • Trauma
  • Fractures
  • Limb immobilization
  • Longer than normal healing time
  • The use of certain medications such as ACE inhibitors

Symptoms

Symptoms usually appear after an injury. The most important symptom of CPRS is prolonged pain that may be constant or severe. Pain is typically described as burning, throbbing, aching, squeezing, or shooting.

Symptoms of CRPS change over time and may include:

  • Sensitivity to touch or even a light breeze
  • Swelling in the arm or leg
  • Unusual sweating patterns
  • Excessively warm or cool skin
  • Hair and nails that become brittle and crack
  • Abnormal movement in the arm or leg, such as a tremor, jerking, or spasms
  • A pale, blue, and/or shiny look to the skin
  • Limited joint movement

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done.

The common characteristics of CRPS include:

  • An initial traumatic or painful event
  • Pain in the upper or lower extremities
  • A recent heart attack or stroke
  • Continuing pain in the limb that is out of proportion to any stimulus, such as pain with even light touch
  • Swelling, changes in skin blood flow, movement problems, or temperature changes only in the affected limb
  • No other cause for the symptoms

Tests may be ordered to rule out other conditions. You may be referred to a pain specialist.

Images may be taken of your bodily structures. This can be done with:

The electrical activity in your nerves and muscles may need to be tested. This can be done with:

You may need to have your body's heat measured. This can be done with a thermogram.

You may need to have your autonomic nervous system evaluated. This can be done with quantitative sudomotor axon reflex test (QSART), resting sweat output (RSO), or the resting skin temperature (RST).

Treatment

Treatment aims to relieve pain and improve function. Early therapy may lead to better outcomes. In some cases, the condition goes away on its own; this is more common in children. Talk with your doctor about the best treatment plan for you. Options include:

Physical and Occupational Therapy

Physical and occupational therapy may help reduce pain and increase mobility.

Counseling

Long-term pain often leads to depression or anxiety . Counseling is often required to help patients deal with chronic pain and loss of function.

Cognitive behavioral therapy may help you manage pain. It is a form of talk therapy that focuses on how the way you think affects the way you feel and act.

Medications

Your doctor may recommend the following medications:

  • Pain relievers
  • Bisphosphonates
  • Antiseizure medications
  • Topical pain relievers that are applied to the skin
  • Corticosteroids

Surgery

A surgical procedure called sympathectomy can permanently destroy sympathetic nerves. In some cases however, surgery may worsen symptoms.

Other Treatments

A device may be implanted in your spine. It will deliver electric stimulus to your spinal cord to manage pain.

Prevention

There are no known ways to prevent CRPS.

Revisions

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