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Understanding Complex Regional Pain Syndrome (CRPS)

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Complex regional pain syndrome (CRPS) or reflex sympathetic dystrophy is a disorder characterized by chronic persistent pain of the limbs. It can sometimes occur spontaneously, but more often than not, it happens after an injury or surgery.

According to available studies, this disease has an incidence rate of 6.28 per 100000 person-years. But, unfortunately, it will not stop there; the numbers will keep climbing up as more people develop CRPS without getting the proper diagnosis and treatment they need.

To better understand the disease, here are important facts that you need to know about complex regional pain syndrome. We will tackle every detail about the disorder’s causes, symptoms, and treatment strategy below.

What Is Complex Regional Pain Syndrome?

CRPS or complex regional pain syndrome refers to a condition that causes intense aching and swelling to the limbs, which can be triggered by trauma or surgery. It can occur anywhere in the body, but in most cases, it affects the extremities: arms, hands, legs, and feet.

Like many other disorders, CRPS can affect anyone regardless of age. But studies suggest that the syndrome mostly develops in adults from the mid-thirties to 40s and seniors (61 to 70). In addition, it primarily affects women three to four times more often than men

What Are the Symptoms of CRPS? 

Persistent, burning pain is one of the most predominant symptoms experienced by individuals with complex regional pain syndrome. It may differ in degree and severity, but most pain sensations felt by patients are reported to be greater than the pain of the injury or trauma itself. 

For instance, you might only attain a minor injury to your big toe, but because of CRPS, you’ll be able to feel a much more intense pain that will spread from the toe to your calf or leg.

Moreover, CRPS usually progresses gradually and follows these three stages of symptom development.

complex regional pain syndrome

Stage 1

This stage starts during the first three months of your battle with CRPS. Besides the searing ache, other symptoms may include:

  • Stiffness and swelling in the affected part
  • Reduced or loss of range of motion
  • Changes in skin color and temperature (affected area may sometimes feel warm and dry)
  • Sensory changes (e.g., increased sensitivity to pain)
  • Changes in hair and nail growth in the affected limb.
  • Muscle spasms

Stage 2

In this stage, every symptom you experienced in stage 1 will increase in severity. The skin also exhibits a cooler temperature and glossy texture due to constricted blood vessels.

Additionally, patients might also experience loss of motor abilities due to muscle weakness and limited mobility in the affected area. This will last for about 3 to 6 months.

Stage 3

If still left unaddressed, affected muscle limbs will waste away due to lack of movement and function. 

What Are the Causes of CRPS?

As of late, science has yet to find the exact cause of complex regional pain syndrome. However, in most cases, CRPS develops after a traumatic injury or surgical procedure involving the soft tissues. In fact, 41.3% of reported cases were due to fractures. Some other examples include sprains, strains, contusions, nerve lesions, and stroke.

According to studies, tissue trauma due to injuries may stimulate the immune system to release inflammatory chemicals into the affected area. This will then cause you to feel stinging sensations, swelling, and temperature changes.

According to other research, CRPS may also be caused by the dysfunction or alteration of the nervous system. This malfunction may get triggered by tissue damage and the increased activity in the CNS and sympathetic nervous system.

Other theories regarding the causes of the disease point towards genetics and psychological factors, like stress and anxiety.

What Are the Two Types of Complex Regional Pain Syndrome?

CRPS has two types: Type I or reflex sympathetic dystrophy and Type II or causalgia. These two divisions have the same hallmark symptom manifestation in the body (e.g., nerve discomfort, swelling, skin changes, etc.). However, they differ in their causative or inciting events:

  • Type I CRPS occurs without nerve damage.
  • Type II CRPS happens as a result of a specific nerve injury.

How Is Complex Regional Pain Syndrome Diagnosed?

There’s no gold standard test to diagnose CRPS. Most pain management doctors rely on patient history, physical examination (Budapest criteria), and clinical exams. Some specific examples include:

The Budapest Criteria

Developed by the IASP, the Budapest criteria were designed to diagnose CRPS based on the consistency of a patient’s signs and symptoms with the disease itself. Some of the clinical measures included are:

  • Nerve pain (allodynia) or persistent aching that’s higher than usual.
  • Changes in temperature and skin color.
  • Changes in sweating.
  • Limited range of motion and changes in hair and nails.

Having at least two of the symptoms above may mean that a patient has CRPS. But only if the symptoms are progressing and other diseases have been ruled out.

Triple Phase Bone Scan

This procedure will let your doctor see any changes in the bone and an increase in blood flow in the affected area. This test will also rule out a TYPE I CRPS case.

Infrared Thermography

An IRT can detect the temperature of the affected limb and compare it to the normal one. Patients with CRPS have an increased skin temperature due to blood pooling in the affected area. Most specialists use infrared thermography to support their diagnosis of CRPS as it has a 93% sensitivity to the disease.

Imaging Tests

Imaging methods like an X-ray procedure can determine if there’s a loss of minerals in the bones of the affected area. 

Additionally, an MRI or magnetic resonance imaging can help confirm the presence of swelling and joint and tissue changes. Plus, it can aid in viewing atrophied tissues during the late stage of CRPS.

treatment options for Complex Regional Pain Syndrome

What Are the Treatment Options for Complex Regional Pain Syndrome?

Both Type I and Type II CRPS still have no cure. Treatment for this syndrome is primarily directed to relieve its symptoms and improve the condition and life of the patients. 

Non-surgical Procedures

Doctors may opt to use non-invasive treatment methods during the early stages of complex regional pain syndrome. This includes:

  • Pain-relieving drugs, blood pressure medications, steroids for inflammation, anti-seizure, and antidepressants.
  • Physical and occupational therapy to help reduce discomfort, preserve the affected limb’s function, and prevent muscle loss.
  • Psychotherapy and counseling
  • Desensitization techniques to decrease the sensory stimulation of the affected area.

Surgical Procedures

If the body is not responding to non-invasive methods, your doctor might resort to surgical procedures to provide relief and improve your health condition. Some examples of invasive techniques used to treat CRPS include:

  • Sympathetic nerve blocks - this procedure helps in pain management by numbing the nerves and preventing them from relaying pain sensations to and from the area.
  • Intrathecal drug pumps - used to supply painkilling medications directly to the spinal fluid.
  • Spinal cord stimulation - a device will be implanted near the spinal cord to help interfere with the pain signals sent from the affected area to the brain. 
  • Surgical removal of the affected nerves.

Learn More About CRPS and Pain Management from the Experts at Pain Care Specialists of Florida

Complex regional pain syndrome conditions require proper diagnosis and immediate assessment from the best pain management specialists and therapeutic team. 

At Pain Care Specialists of Florida, we provide exceptional patient care services and procedures to bring relief and improve your quality of life. 

If you are currently suffering from pain-inducing symptoms and diseases, then you can schedule a consultation with one of our experts and get a thorough assessment of your health and treatment options. You can visit one of our clinics conveniently located near you:

If you have any questions or would like to schedule an appointment, please reach out to contact us today! 

The material contained on this site is for informational purposes only and DOES NOT CONSTITUTE THE PROVIDING OF MEDICAL ADVICE, and is not intended to be a substitute for independent professional medical judgment, advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare providers with any questions or concerns you may have regarding your health.

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