Complex Regional Pain Syndrome
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Complex Regional Pain Syndrome (CRPS) is a condition that typically affects a specific area of the body, often the extremities, and is characterized by symptoms such as pain, changes in skin color, and other sensations.
People who experience complex regional pain syndrome (CRPS) typically report pain in their arms or legs. This condition often arises after an injury, surgery, stroke, or heart attack, and the level of pain experienced is disproportionate to the initial injury’s severity.
Adults are more frequently affected by CRPS than children. Around 40 years old is when the peak onset occurs. People assigned as female at birth experience CRPS more frequently than people born as male. Most cases—between 66% and 80%—are seen in people of European ancestry.
CRPS is a rare condition and the cause is unknown. Early treatment offers the best chance for success, with recovery and even remission being possible in these cases.
Symptoms
CRPS symptoms and signs include:
- Sensitive to cold or touch
- Continual throbbing or burning pain, commonly in the hand, foot, arm, or leg
- Swelling in the location of pain
- The hair and nails grow differently
- Joint inflammation, stiffness, and damage
- Weakness (atrophy), tremors, and muscle spasms
- Reduced mobility of the affected body portion
- You may experience a difference in temperature on the skin of your extremity compared to the opposite one. This could manifest as either a sensation of warmth or coolness.
- Alterations in skin color, ranging from white and blotchy to red or blue
- Alterations in the appearance of the skin, which could become tender, shiny or thin in the affected area
Symptoms can vary from person to person and can alter over time. Typically, symptoms like pain, swelling, redness, temperature changes that are apparent, and hypersensitivity (especially to cold and touch) come first.
CRPS is a condition that can cause various symptoms in a specific part of the body, typically the limbs, including pain, changes in skin color, and other symptoms. Over time, the affected limb may become colder and paler, and may experience muscle stiffness, spasms, and changes in the skin and nails. In some cases, when these changes occur, the condition may become difficult to cure.
On rare occasions, CRPS can travel from its site to another part of the body, like the opposing limb.
For some individuals, the signs and symptoms of CRPS can resolve spontaneously, while others may experience them for an extended period, even lasting several years. Starting treatment early in the disease course is more likely to be effective in managing the condition.
Consult your doctor to find out what’s causing any ongoing, excruciating pain in a limb that makes using or touching it appear intolerable. Early CRPS treatment is important for the best chance of recovery and possible remission.
Causes
Although the exact cause of CRPS is not entirely clear, it is thought to arise from an imbalance or damage to the peripheral and central nervous systems. Typically, this condition occurs following a trauma or injury.
There are two forms of CRPS that have comparable symptoms but different underlying causes:
- Type 1. Reflex sympathetic dystrophy (RSD) develops following an illness or injury that didn’t directly harm the nerves in the affected limb. Ninety percent of those who experience CRPS are type 1 sufferers.
- Type 2. This type, formerly known as causalgia, exhibits symptoms that are comparable to those of type 1. However, type 2 CRPS develops after a specific nerve damage.
Many CRPS cases follow a forceful trauma to the arm or leg. This might involve a fracture or a crushing injury. CRPS can also result from other major and minor traumas, including surgery, heart attacks, infections, and even sprained ankles.
Why these damages can cause CRPS is not entirely clear. Not every person who sustains this kind of injury will later develop CRPS. It could be brought on by unusual interactions between your central and peripheral nerve systems as well as other inflammatory reactions.
Diagnosis
Although there is no single test that can accurately diagnose CRPS, a diagnosis is typically made based on medical history and physical examination results. However, the following procedures may provide important information:
- Bone scan. Finding bone changes could be aided by this procedure. Your bones can be observed with a special camera after having a radioactive material injected into one of your veins.
- Sweat production tests. The amount of sweat on both limbs can be measured by certain techniques. Uneven outcomes could be a sign of CRPS.
- X-rays. Later stages of the disease may cause mineral loss from your bones, which will be visible on an X-ray.
- Magnetic Resonance Imaging (MRI). An MRI test’s images may reveal tissue changes that rule out other illnesses.
Treatment
Some data suggests that CRPS symptoms may be improved with early treatment. Frequently, a mix of many therapies adapted to your unique situation is required. Options for treatment include:
Medications
To treat CRPS symptoms, doctors use a variety of drugs.
- Pain relievers. Aspirin, ibuprofen, and naproxen sodium, which are accessible over-the-counter painkillers, may reduce minor pain and inflammation.
If over-the-counter medications are ineffective, your doctor may recommend harsher painkillers. Drugs that include opioids may be a possibility. They might aid in pain management when used sparingly.
- Antidepressants and anticonvulsants. When a damaged nerve causes pain (neuropathic pain), antidepressants like amitriptyline and anticonvulsants like gabapentin may be used to treat it.
- Corticosteroids. Prednisone and other steroids may lessen inflammation and increase mobility in the injured limb.
- Bone-loss medications. Your provider may suggest medications to prevent or stall bone loss, such as alendronate and calcitonin.
- Sympathetic nerve-blocking medication. Some persons may have pain relief after an injection of an anesthetic to block pain fibers in the afflicted nerves.
- Intravenous ketamine. Studies suggest that even small amounts of the potent anesthetic ketamine intravenously can significantly reduce pain.
- Medicines to lower blood pressure. Pain management may occasionally be assisted by high blood pressure drugs such as clonidine, phenoxybenzamine, and prazosin, among others.
Therapies
- Topical pain relievers. There are several topical medications that can lessen hypersensitivity, such patches or creams containing lidocaine or the over-the-counter capsaicin cream.
- Heat therapy. On skin that feels chilly, applying heat may provide relief from discomfort and swelling.
- Mirror therapy. A mirror is used in this kind of therapy to deceive the brain. You move the healthy limb while seated in front of a mirror or mirror box so that the brain sees it as the CRPS-affected limb. According to research, this kind of therapy may benefit CRPS patients by enhancing function and lowering pain levels.
- Physical or occupational therapy. Pain may be reduced and range of motion and strength may be increased with gentle, supervised exercise of the afflicted limbs or with modification of regular activities. Exercises may be more beneficial depending on how soon the condition is identified.
- Transcutaneous Electrical Nerve Stimulation (TENS). Electrical impulses can sometimes be applied to nerve endings to reduce chronic pain.
- Biofeedback. Learning biofeedback skills may be helpful in some situations. You may relax your body and get rid of pain by using biofeedback, which teaches you to become more conscious of your body.
- Spinal cord stimulation. This technique involves the insertion of small electrodes along the spinal cord by a healthcare provider. The application of a low-level electrical current to the spinal cord can help reduce pain.
- Intrathecal drug pumps. Painkillers are injected directly into the spinal fluid in this treatment.
- Acupuncture. Long, thin needles inserted into the body may stimulate the nerves, muscles, and connective tissue to improve blood flow and reduce pain.
Recurrences of CRPS can occur, sometimes triggered by factors such as exposure to cold or significant emotional stress. To address these recurrences, a low dose of an antidepressant or other medication may be used.
