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Complex Regional Pain Syndrome

Complex regional pain syndrome (CRPS), also know as reflex sympathetic dystrophy (RSD) or causalgia, is a complex chronic pain condition that typically causes pain in the extremities —  either the arm or leg. CRPS can sometimes be an overlooked condition, either completely missed or confused for other medical problems such as infection.

CRPS usually is associated with an initial traumatic or painful event to a limb. The pain generally continues in the limb despite the external appearance of being healed. The pain may seem out of proportion to any stimulus, even non-painful stimuli. In addition, it is also somewhat a diagnosis of exclusion because other conditions should be ruled out.

Symptoms

Symptoms typically include significant and severe pain in the affected limb that seems out of proportion to the initial injury or that seems to persist despite the appearance of a healed wound or injury. There may not be any readily visible symptoms on evaluation, but typically there are signs of swelling, changes in skin blood flow, and changes in color or temperature only in the affected limb. There also may be abnormal excessive sweating and abnormal or excessive hair and nail growth patterns.

If these symptoms persist untreated, permanent damage can take place to the affected limb. This can include expansion of the painful areas beyond the initial injury, muscle weakness and deterioration, loss of function of the limb, and potential thinning of the bones (osteoporosis) in the affected limb.

Causes

The cause of CRPS is not completely understood. The condition likely results from several factors. One theory is that it involves overactivity of the sympathetic nervous system. The sympathetic nervous system is typically responsible for control of automatic body functions such as heart rate, blood pressure control, sweating, etc. Other possibilities involve a dysfunctional bodily inflammatory response or a dysfunctional interaction between the peripheral nervous system (nerves in the extremity) and the central nervous system (the spinal cord and brain).

There are two types of CRPS - type 1 and type 2. Type 1 typically are the above symptoms in the context of an injury that did not cause a direct nerve injury. Type 2 describes the above-mentioned symptoms after a distinct nerve injury occurs.

Treatments

Your doctor at the JLR Center for Pain Medicine will decide on the right plan of care for you depending on your symptoms and after complete examination. A thorough history and physical exam will allow us to tailor a plan of care unique to your symptoms.

Early treatment focuses on confirmation of the diagnosis and aggressive physical therapy to focus on restoration and maintenance of function in the affected limb. Your doctors may use medications to provide temporary relief of your symptoms and discuss minimally invasive injections such as stellate ganglion block for upper extremity CRPS or a lumbar sympathetic plexus block for lower extremity CRPS.

These blocks provide diagnostic confirmation and, when done initially as a series, may afford you a better opportunity to optimize performance during physical therapy. Ultimately, refractory cases of CRPS may be treated with spinal cord stimulation or an intrathecal pump