Conditions

Overview

Complex Regional Pain Syndrome (CRPS)

Complex regional pain syndrome (CRPS) can occur at any age, but usually affects men and women in their early- to mid-forties, with women more likely to be impacted. CRPS is chronic arm or leg pain that develops after an injury, stroke, surgery, or heart attack. The pain is localised and often disproportionate to the initial trauma.



Causes of Complex Regional Pain Syndrome

There are two types of CRPS:

  • Complex Regional Pain Syndrome I (Reflex Sympathetic Dystrophy); affecting 90% of people with CRPS and resulting of an injury or prolonged period of immobilization.
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  • Complex Regional Pain Syndrome II (Causalgia); resulting of a nerve injury but pain is not limited to the site of the injury.
  • The cause of CRPS is unknown, however, in almost every case, no matter how severe, the pain originates after an injury or trauma. Potential causes are:

    • Prolonged immobilisation, such as being casted
    • Burns
    • Cuts
    • Bruises
    • Sprains
    • Surgery, even as minor as being stuck with a needle
    • Bone breaks and fractures

    Symptoms

     

    Regardless the severity of the initial injury, CRPS symptoms may not present themselves right away. In every case, symptoms include a tingling or burning sensation in the lower and/or upper extremities. The pain may affect the entire leg or arm or may only influence one toe or finger. Other symptoms of CRPS include:

    01

    Joint stiffness

    02

    Skin hypersensitivity

    03

    Skin texture change

    04

    Difficulty moving the affected area

    05

    Hair and nail growth pattern disruption

    06

    Atrophy of muscles

    07

    Swelling in and around joints

    08

    Decreased range of motion

    09

    Allodynia, or pain in the opposite limb

    Diagnosis

    There is no clear-cut test to diagnose CRPS. However, your pain management specialist will examine your medical history and may perform an MRI to detect changes in bone or circulation. Your pain management specialist will also perform tests to rule out other possible conditions.

    Possible Treatments

    Treatment options for CRPS often begin with OTC pain relief medication or prescription medications, such as pain relievers, corticosteroids, antidepressants, anticonvulsants, or bone loss medications. Physical therapy, psychotherapy, and biofeedback are additional common treatment options, but perhaps the most effective treatment option available in the United States is dorsal root ganglion stimulation.

    Dorsal root ganglion stimulation is a surgical procedure in which a pulse generator with leads attached is placed underneath the skin in either the abdomen or the buttocks. The leads send tiny electrical pulses to the dorsal root ganglion, the location in the spinal cord through which every sensory perception must pass, and thus, block the pain influenced by CRPS.

    Other interventional pain management treatments are:

    Sympathetic nerve blocks: a block to the sympathetic nerves is applied via an aesthetic adjacent to the spine
    Ketamine IV infusion therapy: ketamine is given intravenously over a period of several days.
    Surgical sympathectomy: the nerves contributing to CRPS are destroyed.
    Spinal cord stimulation: electrodes are placed adjacent to the spinal cord
    Intrathecal pumps: pain relief medication is sent to the pain site via an implanted catheter or pump.
     
     
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