What is complex regional pain syndrome (CRPS)?
CRPS, also known as Reflex Sympathetic Dystrophy (RSD), is a chronic pain condition of the Sympathetic Nervous System, caused by damage to one or more limbs of the feet, arms, legs, or hands. The person may experience constant, extremely intense, and debilitating pain accompanied by extreme sensitivity, dramatic skin color change, and inflammation in the affected area. Abnormal microcirculation caused by damage to the nerves that regulate blood circulation and temperature is the primary cause of such sensation and pain.
The affected limb may feel cooler or warmer than other limbs. There are two types of CRPS – CRPS II and CRPS I. CRPS-II, earlier known as causalgia, is a condition in which patients suffer definable major nerve injury. CRPS I, formerly called reflex sympathetic dystrophy syndrome, may follow a small fiber nerve injury, fracture, trauma, infection, burn, strain, sprain, tear, bursitis, tendonitis, or arthritis.
What are the symptoms?
Prolonged, often constant, pain is the main CRPS symptom. Some patients may experience extremely severe, uncomfortable, and debilitating pain in the affected area, causing long-term disability. It may feel like a “pins and needles” type of burning sensation. In initial stages, the patient feels as if someone is squeezing the affected limb, with increased sensitivity that even light touch feels uncomfortable. Gradually, the pain may spread to the leg or arm and even shift to the opposite extremity.
Other common symptoms include:
- altered nail/hair growth patterns
- changes in skin texture, which may appear thin, shiny
- stiffness in affected limbs
- increased sweating in the affected limb
- tremors/jerking of the affected limb
- coordination problem in muscle movement, with reduced ability in moving the affected body part
- constant chronic burning sensation/pain
- Some patients may experience sensitivity to light and sound, irregular heart rhythms, digestive issues, bladder problems, memory loss, gynecologic problems, and compromised immune system.
Which body parts are involved?
CRPS usually affects one, two, or all four extremities, including back, shoulders, face, eyes, or other parts of the body. It typically involves muscles, skin, nerves, bones, and blood vessels. Most patients develop problems following an injury, which may be a fall, vehicle accident, or trauma.
How is CRPS/RSD diagnosed?
A clinical diagnosis by a neurologist is the best way to get a diagnosis of CRPS done. The doctor will begin by asking you questions about your medical history and then perform a physical exam. Patients should inform the CRPS-educated physician about any of the following symptoms:
- Persistent pain long after the injury has healed
- Changes in skin color or texture – dryness, redness, tightness, rashes, sores
- Increase in sweating
- Too much pain considering the proportion of the injury sustained
- Constant chronic burning pain
- Muscle spasms
- An injury that could have damaged a nerve
- Short-term loss
- Concentration problems
- Sensitivity to smell, sound, vibration, touch, barometric pressure changes
The Boulder pain management doctor may perform X-ray, infrared imaging, thermography, bone scan, CAT scan, Quantitative sudomotor axon reflex test, MRI, electromyography, nerve conduction studies, and acupuncture to identify sympathetic dysfunction signs.
What is the treatment for CRPS/ RSD?
Treatment at Colorado Clinic’s pain management centers in Boulder, Loveland and Greeley focuses on relieving pain and improving function in the affected limb. Treatment options may include acupuncture, biofeedback, injections to prevent transmission of signal to sympathetic nerves, physical therapy, psychological support, anti-anxiety medications, mirror box therapy, and sympathectomy or surgery to destroy sympathetic nerves.