Complex Regional Pain Syndrome (CRPS)

Overview

Complex regional pain syndrome (CRPS) is a form of chronic pain that can develop in the wake of a stroke, heart attack, injury, or surgery on an arm or leg. This condition is quite rare, and its cause is not yet clearly known. The pain caused by CRPS is often disproportionate to the pain caused by the trauma to the region, and you may experience an increased perception of pain in normal activities such as touching your skin. Some living with this condition may experience increased sensitivity to painful stimuli or total sensory loss. Many living with this condition will experience motor impairment in the affected limbs.

Early diagnosis and treatment are important, as this condition may progress into more disabling and severe symptoms such as atrophy or permanent tightening of your muscles. Treatment is more effective when started early, so catching this condition early is vital. Many of the changes your limbs experience with this condition may not be reversible. There are some ways to prevent the development of CRPS, such as taking vitamin C following a wrist fracture or early mobilization following a stroke.

Treatment options

Pain relievers:
- Over-the-counter pain relievers such as aspirin, ibuprofen, acetaminophen, and naproxen sodium may help relieve mild pain and inflammation.
- Topical creams such as lidocaine can help reduce pain.
- Your doctor may prescribe you stronger pain relievers or antidepressants or anticonvulsants to treat nerve pain.
- To help prevent or reduce bone loss, your doctor may prescribe bone-loss medication.
Nerve block, such as stellate ganglion block
Corticosteroid injections
Heat therapy
Physical or occupational therapy
Transcutaneous electrical nerve stimulation (TENS)
Biofeedback or psychotherapy therapy
Spinal cord stimulation
Intrathecal drug pumps
Surgery or amputations: these are typically only used for severe cases when every other treatment option has failed.

Symptoms

The symptoms may vary from person to person, but the initial symptoms of CRPS are:

Pain
Swelling
Changes in temperature and hypersensitivity to cold and touch

Other symptoms include:

Changes in skin temperature, color, or texture
Changes in hair or nail growth
Continuous burning or throbbing pain in arm, leg, hand, food
Decreased mobility in the affected body part(s)
Joint stiffness, swelling, and damage
Muscle spasms, tremors, weakness, or atrophy
Sensitivity to touch and temperature

Your symptoms can spread elsewhere in your body, such as the opposite limb or another nearby limb.

Diagnostic tests

There is no single test that diagnoses CRPS, so your doctor will use a combination of tests, physical exams, and examinations of your medical history to diagnose you. Before seeing your doctor, keep a log of your symptoms, their severity and frequency, and any injuries. Your doctor will ask you questions about this and about any medications, supplements, or vitamins you take. If someone in your family lives with CRPS, let your doctor know, as this condition may have genetic factors.

Your healthcare professional may order diagnostic tests such as:

Bone scan
MRI
Nerve conduction studies
Sweat production test
Ultrasound
X-ray

Types

Type 1: (also known as reflex sympathetic dystrophy) occurs after illness or injury that didn’t directly damage nerves in the affected limb
Type 2: occurs after an injury directly to the nerve

Causes

The cause of CRPS is not yet completely understood, but current research suggests it’s caused by an injury or an abnormality of the peripheral and/or central nervous systems. Minor or major traumas, such as minor sprains, surgeries, infections, or heart attacks. Not everyone will develop CRPS following nerve trauma or injury, and some will develop CRPS without any trauma to the affected nerve or limb.

Facts

The majority of people living with CRPS live with Type 1 CRPS occurs more frequently in women than men and is considered a rare disease, as it only affects about 5.46 people per 100,000 annually.