About Complex Regional Pain Syndrome

Complex Regional Pain Syndrome (CRPS) is a chronic, progressive pain disorder that affects the nervous system. CRPS remains a relatively unknown disorder, but it's estimated to affect 1.5 to 3 million Americans, and women account for 75 percent of people with CRPS according to the Reflex Sympathetic Dystrophy Syndrome Association.

History

• Complex Regional Pain Syndrome was first described by Dr. Silas Weir Mitchell during the Civil War. Soldiers that had been shot complained of a burning pain weeks after removal of the bullets. Dr. Mitchell called it causalgia, which is Greek for "burning pain." Over the years, CRPS has been known by many names including Sudeck's atrophy, neurovascular dystrophy and reflex sympathetic dystrophy (RSD). In 1995, the International Association for the Study of Pain (IASP) changed it to Complex Regional Pain Syndrome in order to more accurately reflect the complexity of the disorder because RSD didn't adequately describe all of the signs and symptoms.

Features

• The main symptoms of CRPS are severe pain and burning. Skin discoloration and temperature changes occur due to the lack of blood flow. This causes the skin to feel cold or hot, and to appear a color from purplish-blue, to shades of red. Hair and nails may grow faster or slower than normal. Allodynia is sensitivity to stimuli that is not normally painful, causing the lightest touch or slightest breeze to result in increased pain. Slow healing time and frequent infections are a sign the immune system is affected.

Diagnosis

• Diagnosis of CRPS is based on medical history, neurological exam and physical findings. Complex regional pain syndrome can start after a sprain, broken bone or surgery among others. Pain that continues and worsens after an injury or surgery beyond the normal healing time could be an indication of CRPS. A doctor looks for neurological changes such as muscle weakness, abnormal reflexes and a reaction to non-painful stimuli that produces pain. Physical changes the doctor looks for include atrophy of the affected limb, changes in skin color and temperature, swelling and stiffness in the joints.

Treatment

• Treatment consists of a multi-faceted approach using a combination of therapies to find what works for each person. Physical therapy is ordered to keep the limb flexible and maintain range of motion. Desensitization therapy may also be included for people who have extreme sensitivity. Medications given include pain medication, anti-inflammatory medicine for swelling, anti-depressants, anti-convulsants and muscle relaxants. Sympathetic nerve blocks are done to try and interrupt the pain cycle, and to improve circulation. Other treatments include a TENS unit, morphine pump, spinal column stimulator (SCS) and lidocaine infusions.

Expert Insight

• Once a person has CRPS, they have it for life. There is no cure for CRPS, but there is a chance of remission. If remission is achieved, CRPS may come back as a result of another injury and sometimes for no reason at all. CRPS can spread to the whole body as well as internal organs. Ice should never be used on a person with CRPS because it causes extreme pain for the people with cold skin. Those with hot skin usually find relief using ice without an increase in pain. Triggers such as loud noise, changes in the weather, stress, and vibrations felt when riding in a car can cause an increase in pain.