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Complex Regional Pain Syndrome or CRPS, formerly referred to as Reflex Sympathetic Dystrophy is a condition of chronic pain that is usually centered around a leg or an arm. CRPS is known to develop after the body has undergone trauma such as an injury, a stroke, a heart attack or a surgery.
It is not known exactly what causes CRPS although it is generally considered that it can be caused by an abnormality in the peripheral and central nervous system, sometimes resulting from an injury or trauma of some sort. The pain felt because of the condition is much higher than that of the injury itself.
Complex regional pain syndrome manifests itself in one of two types. Type 1 is also known as reflex sympathetic dystrophy syndrome, RSD, which is the type nearly 90 percent of CRPS patients suffer from. RSD begins after the patient is struck by an illness or injury that did not cause direct damage to the nerves. Type 2 is called causalgia and results from a direct and definitive injury to the nerves. Both types exhibit similar symptoms.
Complex regional pain syndrome can occur at any age but of the known cases, the disease develops most between the ages of 40 and 60. Females, more specifically, females of postmenopausal age, are more likely to develop CRPS more often than males. Studies are still inconclusive about exactly who is more susceptible to the disease and what the particular risk factors are but some frequent injuries leading to CRPS are a fracture of the distal radius, ankle dislocation, and an intra-articular fracture. Other potentially at risk are those that feel the pain of notably higher levels than normal during the early stages after the trauma has occurred. However, these factors do not account for all cases and many individuals presenting these issues do not develop complex regional pain syndrome.
Symptoms of this condition are known to vary from one case to another. However, the most initial and definitive symptom is a pain. The severity of the pain, of course, is not the same for all of those affected. This is usually accompanied by swelling and redness in the affected limb. The pain can feel like a burning or throbbing sensation. A hypersensitivity to temperature, hot or cold is also common. Other symptoms include changes in skin texture, color or temperature. The limb can go from looking white to either blue or red. The skin may also become tender and inflamed. Other changes can include abnormalities in nail and hair growth. Joints in the limb could become stiff and muscle spasms and tremor could occur along with the weakness and decreased movement in the injured limb. Once the limb starts to look pale and muscle spasms and tightening occur, the condition has probably become irreversible.
Conditions of complex regional pain syndrome may sometimes spread to other parts of the body, commonly to the opposite limb. In some cases, the symptoms may disappear after a while but may remain consistent for several months to years.
Diagnosis for complex regional pain syndrome is started with a physical examination during which the doctor will evaluate the physical symptoms. The doctor may press down on different points in the limb to check for tenderness or move the limb in different directions to evaluate the range of motion and condition of the joints. A medical history of the patient is also required to determine the trauma that may have led to the development of the condition.
Although no single test can completely diagnose CRPS, many different ones can be conducted to effectively judge symptoms and come to a conclusion. Bone scans help in determining if and where changes have occurred in the bone. The scan is done by injecting a radioactive substance into the veins so that they may be visible under a special camera. Sympathetic nervous system tests determine abnormalities in the sympathetic nervous system. One of these is thermography, which checks the temperature and blood flow to the limbs. If the blood flow is uneven in the affected and unaffected limbs it may signal CRPS.
If diagnosed in the later stages, X-rays can show a loss of minerals from the bone. Other imaging tests like magnetic resonance imaging or MRI scans can help in determining changes to the tissues.
There is no cure for complex regional pain syndrome, as of now, but a combination of different treatments together can significantly help in controlling the symptoms. Treatments are most effective if started within the first few months when symptoms begin showing up. Treatment combinations are devised on a case to case basis, depending on the type of symptoms and their severity.
Various medications are available to manage symptoms of CRPS. For the mildest cases, over the counter pain relief medicines like ibuprofen could suffice in treating the pain. Opioids might be prescribed for more severe cases for a limited time under proper supervision by the physician. Some antidepressants can ease neuropathic pain. For some individuals, corticosteroids may be prescribed for a time to reduce inflammation in the limb. Other medications include bone-loss medication and sympathetic nerve-blocking medication. Some studies have also come out in favor of intravenous ketamine for pain relief.
Doctors may recommend different types of therapies to cope with the pain and other symptoms. Application of heat or some topical treatments like lidocaine cream can relieve pain, swelling, and hypersensitivity. Mirror therapy is used to trick the brain into improving the functions of the affected limb. The patient is made to sit before a mirror and move the healthy limb, which the brain perceives as the movement of the injured limb.
Physical therapy is an important treatment for CRPS. A physical therapist guides the patient through exercising the affected limb to relieve pain, improve range of motion, increase flexibility, endurance, and overall strength. Physical therapy produces much better results if the diagnosis is made in the earlier months of the disease developing.
Other types of therapies are transcutaneous electrical nerve stimulations to reduce pain by applying electrical pulses to the nerve endings, and spinal cord stimulation to ease pain by passing current to the spine. Intrathecal drug pumps involve pumping pain relief medications directly into the spinal fluid. Biofeedback is also an effective form of therapy. Learning biofeedback techniques allow the patient to become more aware and in control of their own body to be able to relieve pain by relaxing their body at will.
Living with a chronic disease can impact a person’s mental health as well. It is not uncommon to go through frequent spells of restlessness, anger, frustration. Ways to minimize the impact are to maintain a daily routine as well as possible, get a healthy amount of rest every night, keep regular contact with friends and family and pursue, as best as one can, passions, interests, and hobbies. If the negative emotions and depressing thoughts remain persistent, it is vital to consult with a doctor or a therapist to get proper, professional help. Regular sessions with a licensed therapist or taking prescribed amounts of antidepressants can vastly improve the patient’s mental health and quality of life.