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General overview

Complex regional pain syndrome (CRPS) is a form of chronic pain which affects a leg or an arm and is not a common condition.

It usually occurs after an issue such as an injury, heart attack, stroke or even after surgery and the pain is out of proportion to the severity of the injury that led to the syndrome.

Causes

The causes of CRPS are not clearly understood, but it's thought that certain injuries can trigger the syndrome due to dysfunctional interactions between the central and peripheral nervous systems as well as inappropriate inflammatory responses.

There are 2 types of CRPS which elicit the same signs and symptoms, but the causes are different.

  • Type 1 - this subtype is also called reflex sympathetic dystrophy syndrome (RSDS). This type occurs when the patient experiences an injury or illness which didn't directly affect the nerves in the affected limb. Around 90% of patients diagnosed with CRPS have type 1.
  • Type 2 - this subtype occurs due to a specific nerve injury. It was previously referred to as causalgia.
Emotional stressors can worsen the condition and therefore decrease the chances of remission.

Signs and symptoms

The symptoms of CRPS can change over time and they vary between affected patients. It's important to take note that the syndrome can sometimes spread to another part of the body.

The signs and symptoms of CRPS are as follows:

  • Most commonly, the first symptoms to start include pain, swelling, hypersensitivity to touch and cold, redness and changes in skin temperature (alternating between sweaty and cold) of the affected limb.
  • The limb can then become pale and cold as well as undergo nail and skin changes. Muscle spasms, joint stiffness and tightening of the limb can then also occur. Once these latter changes occur, then the condition is often irreversible.
  • The pain experienced is a continuously throbbing or burning pain.
  • Skin texture also occurs where the skin can be tender, shiny or thin.
  • There's loss of muscle mass which can lead to decreased ability to move the affected limb.
A patient should consult with their doctor if they experience severe, constant pain of the limb which makes moving or touching the limb extremely uncomfortable. 

Management of CRPS

Various treatments have helped manage CRPS to the point of remission, if treated early. The main treatment protocols involve medications and other appropriate therapies

Medication

  • Analgesia/pain medication - anti-inflammatory medications such as ibuprofen, naproxen and diclofenac can help offer relief of symptoms. If they aren't helpful, then patients can be prescribed opioid medications such as codeine.
  • Steroids - prednisone can also be used to help reduce inflammation.
  • Antidepressants/anticonvulsants - drugs such as gabapentin and amitriptyline are used to treat pain from damaged nerves.
  • Medications which prevent bone loss - examples include calcitonin and alendronate.
  • Pain blocks - anaesthetic agents are injected around nerve fibres to reduce the symptom of pain.
  • Intravenous ketamine - low doses of this medication have shown to offer pain relief.
  • Topical analgesics - these have shown to offer relief to symptoms of hypersensitivity.

Therapies

  • Physical therapy - exercising and mobilization of the limb improves blood flow which results in reduced symptoms and increased range of motion. The earlier this is done, the better the patient's prognosis.
  • Heat and cold pack application - this helps to relieve swelling and sweating of the affected limb.
  • Biofeedback - here one learns to be more aware of their bodies which helps with relaxation and therefore reduces pain.
  • Transcutaneous electrical nerve stimulation (TENS) - electrical impulses applied to nerve endings helps to ease chronic pain.
  • Spinal cord stimulation - here, small electrodes are placed in the spinal column where stimulation of the spinal cord occurs to offer pain relief.

 

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