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Complex regional pain syndromes

Complex regional pain syndrome (CRPS) is a chronic pain condition that can affect any area of the body, but often affects an arm or a leg. Doctors are unsure of the cause of CRPS. In some cases, the sympathetic nervous system plays an important role in the pain. Another theory is that CRPS is caused by a triggering of the immune response, which leads to inflammation – redness, warmth and swelling in the affected area.

CRPS has two forms:

  • CRPS 1 is a chronic nerve disorder that occurs most often in the arms or legs after a minor injury or infection
  • CRPS 2 is caused by an injury to the nerve


CRPS is thought to result from damage to the nervous system, including the nerves that control the blood vessels and sweat glands. The damaged nerves are no longer able to properly control blood flow, sensation and temperature to the affected area. This leads to medical problems in the blood vessels, bones, muscles, nerves and skin.

Rarely, sudden illnesses such as a heart attack or stroke can cause CRPS. The condition can sometimes appear without obvious injury to the affected limb. The condition is more common in people ages 40 to 60 but has also been seen in younger people.

Common Symptoms

  • Intense and burning pain much stronger than would be expected for the type of injury that occurred
  • Pain that gets worse over time
  • Pain that begins at the point of injury but often spreads to the whole limb or to the arm or leg on the opposite side of the body


In most cases, CRPS has three stages, but the disorder doesn’t always follow this pattern. Some people develop severe symptoms right away; others stay in the first stage.

Stage 1 symptoms generally last from one to three months:

  • Changes in skin temperature, switching between warm and cold
  • Faster growth of nails and hair
  • Muscle spasms and joint pain
  • Severe burning, aching pain that worsens with the slightest touch or breeze
  • Skin that slowly becomes blotchy, purple, pale or red; thin and shiny; swollen; more sweaty


Stage 2 symptoms may last three to six months:

  • Continued changes in the skin
  • Nails that are cracked and break more easily
  • Worsening pain
  • Slower hair growth
  • Stiff joints and weak muscles


Stage 3 symptoms are marked by irreversible changes:

  • Limited movement in the limb because of tightened muscles and tendons
  • Loss of muscle tone
  • Pain in the entire limb


If pain and other symptoms are severe or long lasting, patients may experience depression or anxiety.

Diagnosis

Although diagnosing complex regional pain syndrome can be difficult, early diagnosis is very important. Your doctor will take a complete medical history and perform a physical exam. Tests may include:

  • Thermography to track temperature changes and lack of blood supply in the affected limb
  • Bone scans
  • Nerve conduction studies
  • X-rays


Treatment

There is no cure for CRPS, but the disease can be slowed. Our main focus in treatment is on relieving the symptoms and helping people with the syndrome live as normal a life as possible. We start our patients on physical and occupational therapy as early as possible. An exercise program that helps you keep joints and muscles moving may prevent the disease from worsening and help you continue to perform everyday activities.

Medications may be used, including pain medicines, steroids, certain blood pressure medicines, bone loss medications and antidepressants.

Some type of talk therapy, such as cognitive behavioral therapy or psychotherapy, can help teach you the skills you need to live with chronic pain.

Invasive procedures may provide relief:

  • Nerve blocks using injected medication to numb the affected nerves or pain fibers around the spinal column
  • An implanted intrathecal drug pump that delivers medication directly to the spinal cord
  • An implanted spinal cord stimulator that places electrodes next to the spinal cord and reduces pain by creating a pleasant or tingling sensation



Source: National Institutes of Health

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