Complex Regional Pain Syndrome (CRPS) RSD
Complex regional pain syndrome (CRPS) is a condition characterized by stiffness, pain, swelling, and discoloration of the hands, legs, and feet. CRPS is also known as reflex sympathetic dystrophy (RSD) or causalgia. There are two types of CRPS: type 1 (occurs after an injury or illness where there is no direct nerve damage) and type 2 (follows a distinct nerve injury).
The incidence of CRPS is not well documented due to scarce data. However, a recent study of the Integrated Primary Care Information project in the Netherlands found that CRPS affects 2.5% of the adult population. Females are three times more likely than males to be affected with CRPS. In addition, the upper extremity is more likely to be affected, with a fracture being the most common precipitating injury.
What are the stages of CRPS?
There are three stages of CRPS. These include:
- Stage I – Lasts for up to three months and is characterized by burning pain, swelling, joint stiffness, and sensitivity to touch. In addition, the patient will notice excessive sweating and faster-than-normal nail and hair growth.
- Stage II – In the second stage, the swelling continues, skin wrinkles, and fingernails become brittle. Also, the affected area is more sensitive to touch and the pain is more widespread.
- Stage III – The atrophic stage is the third stage, where the skin becomes pale, shiny, and dry.
What causes CRPS?
The exact cause of CRPS is not known, but experts recognize that some type of illness or injury precedes the illness. Researchers think that the short circuit in the nervous system causes over-activity of the sympathetic nervous system, and this affects sweat glands and blood flow.
How is CRPS diagnosed?
To diagnose CRPS, the doctor will carefully examine the hands, legs, and feet. A medical history is obtained and diagnostic tests are ordered. There is no tests to diagnose CRPS, but x-rays, bone scans, and MRIs are used to make the diagnosis by exclusion of other conditions.
How is CRPS treated?
Early diagnosis is important for the treatment of CRPS. Nonsurgical measures include:
- Medications – NSAIDS, oral steroids, antidepressants, anticonvulsants, blood pressure medications, and opioids are used to relieve symptoms.
- Injection therapy – This involves injecting an anesthetic near the sympathetic nerves to reduce and alleviate symptoms.
- Therapy – Physical therapy is often used to exercise the affected limb and prevent muscle weakness and atrophy.
- Spinal Cord Stimulation – Works well in over 75% of patients for pain relief.
- Biofeedback – This involves increased body awareness and relaxation techniques that relieve pain.
- Psychotherapy – Complex regional pain syndrome often leads to psychological distress, and the affected individual suffers anxiety, depression, and posttraumatic stress disorder. Psychotherapy is used to alleviate some of these problems.
- Sympathetic nerve block – For a patient with CRPS, a sympathetic nerve block is done. This involves IV administration of phentolamine (drug that blocks sympathetic receptors) or placement of an anesthetic near the spine to block nerve sensations.
How can surgery help CRPS?
There are some surgical interventions to treat CRPS. A spinal cord stimulator can be implanted along the spine to deliver electrical impulses to the affected nerves. Also, a pain pump is an implanted device that delivers pain medication to the spinal cord to reduce symptoms.
What is the prognosis for complex regional pain syndrome?
The prognosis for CRPS will vary from person to person, depending on the severity of symptoms, state of health, and treatment. Spontaneous remission occurs in some people, but others have continuous crippling pain. Many doctors believe that early treatment is the key to alleviating this disorder.