Learn More About Complex Regional Pain Syndrome
Complex Regional Pain Syndrome is a chronic pain syndrome that is not well understood. About three in every 10,000 individuals will develop CRPS. It affects women more than men and is more common in people between the ages of 55 and 75. While not a lot is known about what causes CRPS, there are treatment options available to help manage the condition.
What is Complex Regional Pain Syndrome (CRPS)?
There are two basic types of CRPS: in CRPS I, the symptoms are triggered by a tissue or nerve injury; in CRPS II, symptoms are similar but are not caused by any known injury.
Symptoms of CRPS
The main symptom of CRPS is intense and continuous pain that is more severe than would be expected from the precipitating injury or illness. This pain will get worse over time instead of improving as it heals. It will only affect one extremity, such as one foot, one hand, one arm or one leg.
Symptoms of CRPS can also include:
- Increased skin sensitivity.
- Changes in skin color and hair growth patterns.
- Swelling and stiffness of the affected joints.
- Warmth or coolness in the affected parts of the body.
- Impaired mobility in the area that is affected.
Over time, the symptoms may travel to the opposite extremity. It can also spread over the entire length of the affected arm or leg even when the injury just happens in a finger or toe. Many experts agree that CRPS occurs in a series of three stages:
- Stage 1 - lasts one to three months. This stage is characterized by muscle spasms, severe pain, temperature and skin color changes, and stiffness in the joints.
- Stage 2 - last three to six months. In this stage, people can experience increasing pain severity, joint stiffness, weakened muscles, tissue swelling, and decreased growth in hair and nails.
- Stage 3 - after CRPS has been present for six to nine months, it can progress to the point where the bone, skin and tissue changes are irreversible. Pain persists and often affects the whole limb. This stage is also characterized by muscle atrophy, muscle and tendon contractions
What Causes CRPS?
The exact cause of CRPS is unknown. Experts believe that the sympathetic nervous system may play a key role in the sustained pain. A recent theory suggests that the pain receptors in the legs and arms may begin responding to nervous system messengers that become activated in pain pathways long after the initial injury to the nerves or tissues. Other researchers theorize that CRPS is the result of an immune system response; this, in turn, leads to the inflammatory symptoms that are associated with CRPS.
There is no one diagnostic test that is considered the best method for diagnosing CRPS. There are some tests that can be useful. However, negative results on those tests may not rule out CRPS. A few of the tests used:
- Temperature measurement- usually through surface measurement or infrared thermometry.
- Triple-phase bone scans.
Because of the limitations around tests, CRPS is often diagnosed through four benchmarks:
- Continuing pain that is disproportionate to the original injury.
- At least three of the following: abnormal pain in response to stimulus; asymmetrical body temperature; sweating changes or asymmetry; decreased motor range.
- An absence of other diagnoses that better explain the symptoms.
Treatment Options for CRPS
While there is no cure for CRPS, treatments can help patients improve over time. There are also a number of treatments that focus on pain management. Treatment options include:
- Spinal cord stimulation (SPS). Your doctor can implant a small device near the spinal cord that delivers small bursts of electricity to the spine. In a recent study that followed people who'd had SPS for 12 years, 41% said they had more than 30% pain relief. At a later follow-up, 63% of people with the SPS implant were still using the device.
- Intrathecal drug pumps. These pumps, implanted near the spine, deliver strong pain medication into your spinal fluid. Since the medications bypass your gastrointestinal tract, you are able to avoid the side effects that can be associated with these sorts of medications.
- Nerve blocks. This procedure, known as a stellate ganglion block, provides pain relief to the region of your body affected by a group of nerves. To treat pain from CRPS in your hands or arms, your doctor will inject a long-lasting anesthetic into the front of the neck. You may feel numbness, weakness or warmth for several hours. Three-quarters of patients who have received this treatment report pain relief.
- Surgery. A sympathectomy can be performed to destroy the nerves in the area that is affected. Either a coagulant or a destructive substance like phenol alcohol can be used. This procedure is used only after other treatments have failed to provide relief. About half of people who have the procedure experience relief; over three-quarters say they would do it again.
Request a Consultation
At Performance & Regenerative Medicine, we are dedicated to effective pain management. Dr. Michael T. Harris worked with other pain management practices for years before starting PRM for the express purpose of helping people prevent and manage pain.
Do you have symptoms that could be Complex Regional Pain Syndrome? We can help you get answers and find the best treatments to help reduce your pain and help you get on with your life.