Complex Regional Pain Syndrome



	What Is It? Complex Regional Pain Syndrome (CRPS) is a medical condition and is just what its name implies. CRPS involves all or part of an extremity and exhibits some or all of the following signs and symptoms: Pain, which is usually diffuse, aching, or burning Swelling Hypersensitivity to pressure, touch or temperature Changes in skin color and temperature Stiffness In the past, these changes were felt to be due solely to over-activity of the sympathetic nervous system, which gave rise to the condition's old name, Reflex Sympathetic Dystrophy (RSD). We now know that the sympathetic nervous system changes are only part of the problem, and this new information has resulted in the condition's name change to CRPS. What Causes CRPS? CRPS problems usually begin with an injury (fracture, sprain, crush injury, burn, or penetrating trauma). The degree of trauma does not seem to be directly related to the severity of the symptoms of the condition. In fact, severe cases of CRPS may be the result of a relatively minor injury or uncomplicated surgical procedure. CRPS is divided into two types, depending on whether the initial injury involved trauma to a major nerve. CRPS Type I: without major nerve injury CRPS Type II: with major nerve injury In the past, CRPS Type II was called "Causalgia." The actual means by which some injuries progress to CRPS is not well understood, but there do appear to be some early warning signs and risk factors. They are: Severe, persistent pain out of proportion to the degree of the initial injury or surgery Prolonged immobilization of the extremity Smoking or heavy caffeine use Once established, the condition may deteriorate into a cycle of increasing pain and decreasing mobility of the extremity. This may lead to permanent changes in the skin, muscle and bones, and result in loss of function. In some rare cases, the condition may spread to involve other extremities. How Is It Treated? Since the changes of CRPS increase with time, early recognition is essential to treatment. Treatment involves four main types of therapy. Therapy types may be used in various combinations, depending on the severity of the condition. 1. Medications to decrease nerve sensitivity Gabapentin (Neurotonin) Anti-depressants Analgesics and anti-inflammatory drugs 2. Physical Therapy Range of motion exercises Desensitization Strengthening and conditioning 3. Nerve Blocks Reduce Pain Improve blood flow to the extremity Increase comfort during physical therapy 4. Biofeedback Therapy Teaches patients to self-regulate the nervous system to reduce pain and raise temperature in the affected area Generally treatment is only successful when a specific combination of therapies is applied early and followed strictly. Your physician will recommend the specific combination of treatments to be used. How Long Does The Problem Last? With early and intensive treatment, chances for a complete recovery are good. Gaps in treatment, delay in starting treatment or omitting parts of the treatment plan may increase the chances for the development of chronic pain and progressive loss of function that may be irreversible. I Have Had This Problem For A Long Time. Is There Any Chance For Improvement? Yes. Although chances for improvement decrease with time, the amount of pain and function loss may still be significantly reversed with some of the treatments described above. Advanced pain therapies, such as implanted spinal cord stimulators or implanted spinal drug administration pumps are helpful in some cases. Reduction of pain from these devices provides a therapeutic window of opportunity to initiate an intensive physical rehabilitation program to restore function in the affected extremity. Non-surgical, long-acting sympathetic nerve blocking techniques using radio frequency current applied through precisely place needles are another commonly used treatment in advanced cases. Your physician can discuss with you whether these treatments may be appropriate in your care.