Pain Management: Complex Regional Pain Syndrome

Pain Management: Complex Regional Pain Syndrome

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• Introduction to Complex Regional Pain Syndrome (CRPS)
• What Causes Complex Regional Pain Syndrome?
• What Are the Symptoms of Complex Regional Pain Syndrome?
• How Is Complex Regional Pain Syndrome Diagnosed?
• How Is Complex Regional Pain Syndrome Treated?
• Find a local Neurologist in your town

Introduction to Complex regional pain syndrome (CRPS)

Complex regional pain syndrome (CRPS), also called reflex sympathetic dystrophy syndrome, is a chronic pain condition in which high levels of nerve impulses are sent to an affected site. Experts believe that CRPS occurs as a result of dysfunction in the central or peripheral nervous systems.

CRPS is most common in people aged 20-35. The syndrome also can occur in children; it affects women more often than men.

There is no cure for CRPS.

What Causes Complex Regional Pain Syndrome?

CRPS most likely does not have a single cause but rather results from multiple causes that produce similar symptoms. Some theories suggest that pain receptors in the affected part of the body become responsive to catecholamines, a group of nervous system messengers. In cases of injury-related CRPS, the syndrome may be caused by a triggering of the immune response which may lead to the inflammatory symptoms of redness, warmth, and swelling in the affected area. For this reason, it is believed that CRPS may represent a disruption of the healing process.

What Are the Symptoms of Complex Regional Pain Syndrome?

The symptoms of CRPS vary in their severity and length. One symptom of CRPS is continuous, intense pain that gets worse rather than better over time. If CRPS occurs after an injury, it may seem out of proportion to the severity of the injury. Even in cases involving an injury only to a finger or toe, pain can spread to include the entire arm or leg. In some cases, pain can even travel to the opposite extremity. Other symptoms of CRPS include:

• "Burning" pain
• Swelling and stiffness in affected joints
• Motor disability, with decreased ability to move the affected body part
• Changes in nail and hair growth patterns. There may be rapid hair growth or no hair growth.
• Skin changes. CRPS involves changes in skin temperature -- skin on one extremity can feel warmer or cooler compared to the opposite extremity. Skin color changes also are apparent as the skin is often blotchy, pale, purple or red. The texture of skin also can change, becoming shiny and thin. People with syndrome may have skin that sometimes is excessively sweaty.
• CRPS may be heightened by emotional stress.
• How Is Complex Regional Pain Syndrome Diagnosed?
• There is no specific diagnostic test for CRPS, but some testing can rule out other conditions. Triple-phase bone scans can be used to identify changes in the bone and in blood circulation. Some health care providers may apply a stimulus (for example, heat, touch, cold) to determine whether there is pain in a specific area.
  Making a firm diagnosis of CRPS may be difficult early in the course of the disorder when symptoms are few or mild. CRPS is diagnosed primarily through observation of the following symptoms:
  • The presence of an initial injury
  • A higher-than-expected amount of pain from an injury
  • A change in appearance of an affected area
  • The presence of no other cause of pain or altered appearance

  How Is Complex Regional Pain Syndrome Treated?

  Since there is no cure for CRPS, the goal of treatment is to relieve painful symptoms associated with the disorder. Therapies used includepsychotherapy, physical therapy, and drug treatment, such as topical analgesics, narcotics, corticosteroids, antidepressants and anti-seizure drugs.
  Other treatments include:
  • Sympathetic nerve blocks: These blocks, which are done in a variety of ways, can provide significant pain relief for some people. One kind of block involves placing an anesthetic next to the spine to directly block the sympathetic nerves.
  • Surgical sympathectomy: This controversial technique destroys the nerves involved in CRPS. Some experts believe it has a favorable outcome, while others feel it makes CRPS worse. The technique should be considered only for people whose pain is dramatically but temporarily relieved by selective sympathetic blocks.
  • Intrathecal drug pumps: Pumps and implanted catheters are used to send pain-relieving medication into the spinal fluid.
  • Spinal cord stimulation: This technique, in which electrodes are placed next to the spinal cord, offers relief for many people with the condition.
  SOURCES:
  
  Edited by Ephraim K Brenman, DO on March 01, 2007
  
  'Portions of this page © The Cleveland Clinic 2000-2005

  Featured: Complex Regional Pain Syndrome Main Article

  Complex regional pain syndrome is a chronic pain condition in which high levels of nerve impulses are sent to an affected site is called complex regional pain syndrome (CRPS). CRPS is most common in people aged 20-35. The syndrome also can occur in children; it affect women more often than men.

  Local Resources - Find a local Doctor in your town

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  From:  http://www.medicinenet.com

Complex regional pain syndrome

CRPS; RSDS; Causalgia - RSD; Shoulder-hand syndrome; Reflex sympathetic dystrophy syndrome; Sudeck's atrophy

Last reviewed: March 9, 2010.

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.

Causes, incidence, and risk factors

Doctors aren't sure what causes 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 the inflammatory symptoms of 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.
• 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, feeling (sensation), and temperature to the affected area. This leads to medical problems in the:

• Blood vessels
• Bones
• Muscles
• Nerves
• Skin

Possible causes of CRPS:

• Injury directly to a nerve
• Injury or infection in an arm or leg

Rarely, sudden illnesses such as a heart attack or stroke can cause CSPS. The condition can sometimes appear without obvious injury to the affected limb.

This condition is more common in people ages 40 - 60, but it has been seen in younger people too.

Symptoms

The key symptom is pain that:

• Is intense and burning, and is much stronger than would be expected for the type of injury that occurred
• Gets worse, rather than better over time
• 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. However, CRPS does not always follow this pattern. Some people develop severe symptoms almost right away. Others stay in the first stage.

Stage 1 (lasts 1 - 3 months):

• Changes in skin temperature, switching between warm or 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 (lasts 3 - 6 months):

• Continued changes in the skin
• Nails that are cracked and break more easily
• Pain that is becoming worse
• Slower hair growth
• Stiff joints and weak muscles

Stage 3 (irreversible changes can be seen)

• Limited movement in limb because of tightened muscles and tendons (contracture)
• Muscle wasting
• Pain in the entire limb

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

Signs and tests

Diagnosing CRPS can be difficult, but early diagnosis is very important.

The doctor will take a medical history and do a physical examination. Other tests may include:

• A test to show temperature changes and lack of blood supply in the affected limb (thermography)
• Bone scans
• Nerve conduction studies
• X-rays

Treatment

There is no cure for CRPS, but the disease can be slowed. The main focus is on relieving the symptoms and helping people with this syndrome live as normal a life as possible.

Physical and occupational therapy should be started as early as possible. Starting an exercise program and learning to keep joints and muscles moving may prevent the disease from getting worse and help you perform everyday activities.

Medications may be used, including pain medicines, steroids, certain blood pressure medicines, bone loss medications (such as bisphosphonates like Fosamax and Actonel), and antidepressants.

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

Surgical or invasive techniques that may be tried:

• Injected medicine that numbs the affected nerves or pain fibers around the spinal column (nerve block)
• Internal pain pump that directly delivers medications to the spinal cord (intrathecal drug pump)
• Spinal cord stimulator, which involves placing electrodes (electrical leads) next to the spinal cord. A low-level electrical current is used to create a pleasant or tingling sensation in the painful area, which may help distract from the pain.
• Surgery that cuts the nerves to destroy the pain (surgical sympathectomy), although it is unclear how many patients this helps. It may also make some patients' symptoms worse.

Expectations (prognosis)

The outlook is better with an early diagnosis. If the doctor diagnoses the condition within the first stage, sometimes signs of the disease may disappear (remission) and normal movement is possible.

If the condition is not diagnosed quickly, changes to the bone and muscle may get worse and may not be reversible.

In some people, symptoms go away on their own. In other people, even with treatment the pain continues and the condition causes crippling, irreversible changes.

Complications

• Loss of muscle size or strength in the affected limb
• Spread of the disease to another part of the body
• Worsening of the affected limb

Complications can also occur with some of the nerve and surgical treatments.

Calling your health care provider

Contact your health care provider if you develop constant, burning pain in an arm, leg, hand, or foot.

Prevention

There is no known prevention at this time. Early treatment is the key to slowing the progression of the disease.

References

1. National Institute of Neurological Disorders and Stroke. Complex regional pain syndrome fact sheet. Updated December 21, 2009. Accessed January 19, 2010.
2. Saxton DL, Lindenfeld TN. Complications. In: DeLee JC, Drez D Jr., Miller MD, eds. DeLee and Drez's Orthopaedic Sports Medicine. 3rd ed. Philadelphia, Pa: Saunders Elsevier;2009:chap 7.
3. U.S. National Library of Medicine - The World's Largest Medical Library

Short Coverage of CRPS

Complex Regional Pain Syndrome (CRPS)

A neurological disorder, Complex Regional Pain Syndrome (CRPS) affects peripheral and central nervous systems. Also referred to as Reflex Sympathetic Dystrophy Syndrome, CRPS is a chronic pain condition for which there is currently no cure. Children and adults of any age can suffer from this disease.

What Causes CRPS?

Cases of Complex Regional Pain Syndrome (CRPS) do not always have an underlying cause. For many people, however, the disease occurs following one of several circumstances, including a sprain, a broken bone, or a surgery. Characterized by an intense burning sensation that is not consistent with the injury, CRPS is easily identifiable if physicians know what to look for. Unfortunately, this is not always the case.
Other Symptoms of CRPS
In addition to intense burning of the affected area, patients with Complex Regional Pain Syndrome (CRPS) often experience swelling of the limb, excessive sweating, and discoloration of the affected limb. Often affecting one of the feet, legs, arms, or hands, the pain often radiates along the entire joint or limb of the affected area. This pain can be debilitating in nature. Fortunately, for some sufferers, a sudden remission of the disease does occur. But for many sufferers, the disease is progressive and the pain constant.
Treatment Options for CRPS
There is currently no cure for Complex Regional Pain Syndrome (CRPS). Therefore, people with the disease must seek one or more available treatment options. To alleviate the burning sensation, anti depressants are often prescribed. Other methods of treatment include topical analgesics, cortic steroids, sympathetic nerve blocks and physical therapy. Because a single medication can rarely treat the symptoms of CRPS, many treatment options are often needed to help alleviate pain.
The Future of CRPS
More information is needed for physicians and emergency room staff to be able to prevent incidences of Complex Regional Pain Syndrome (CRPS). By knowing what to look for, the number of occurrences of the disease can diminish. In addition, organizations such as the National Institute of Mental Health are working on ways to more aggressively intervene in cases of traumatic injury in order to prevent CRPS.
If you need legal representation concerning your CRPS case, an attorney familiar with your disease is your best option. With so many people unaware of CRPS, its symptoms, treatments, and preventions, an attorney who has experiences with cases such as yours is vital. CRPS is a painful disease. You do not have to battle it alone. There is someone on your side.

Some Treatments for RSD

Treatment for RSD

Reflex Sympathetic Dystrophy (RSD) is a neurological condition affecting millions of people. The onset of the disease can occur any time during childhood or adulthood, though many cases are seen in people between the ages of 40 and 60.
The disease often originates after a trauma of some sort, including heart attack, stroke, an injury where a broken bone, fracture, bruise, or sprain results, a head injury, or after a surgery. For some sufferers, there is no known origin of the disease.
There is currently no cure for RSD. Because of this, patients must seek various treatment options geared toward managing their pain and symptoms (which may include intense, burning pain; edema; skin discoloration of the affected area; sensitivity to touch, excessive sweating; and limited mobility of the affected area).
Treatment of RSD is not simple. That is because the disease in general is complicated. Some people report no known cause for the onset of Reflex Sympathetic Dystrophy. For others, the disease originates after an injury such as a fall, a broken bone or sprain, a head injury, a heart attack or stroke, or after a surgery. It may also become present in someone with a repetitive motion disorder such as carpal tunnel, or even following a simple bruise.
With such a wide pool of onset possibilities, it's no wonder this disease is difficult to treat, at best. But because there is currently no cure for RSD, treatment of the disease must be aggressive and swift.
Treatment: Why is it so Important?
Unlike many diseases, there is currently no cure for RSD. This is especially difficult because RSD is often a progressive and debilitating disease. Often beginning with an intense, burning sensation in the affected area, the disease can quickly progress to include additional symptoms including sensitivity to touch, excessive sweating, skin discoloration, and restricted movement ability. Treatment is therefore imperative to manage the symptoms of the disease. In RSD cases, early and prompt intervention can mean the difference between manageable pain and years of intolerable suffering.
Treatment Options for RSD Patients
Several possible treatments are available for RSD patients. Because the causes, symptoms, and intensity of the disease vary among individuals, patients often have the most success when they utilize a variety of available treatment options to manage their pain and symptoms.
Treatments for the management of RSD includes topical analgesics, anti-depressants, physical therapy, occupational therapy, and sympathetic nerve blocks. This is only a small sample of the treatments RSD patients may utilize to help them with their symptoms.
Regardless of the treatment option(s) you choose, you may need an attorney to help you with your RSD case. Because the disease is still unknown to many, it may be difficult to prove your need for various treatments and interventions. A qualified attorney who is knowledgeable about your disease can help you get the quality care you need. Don't try to face this disease alone. Attorneys are available to assist you today.

Homeopathic/Holistic Treatment for RSD

Treatments for RSD must begin as soon as possible following diagnosis of the disease. This helps prevent the disease from reaching advanced stages and causing additional chronic pain. Standard treatments for RSD include medications such as topical analgesics and anti-depressants, various therapies, and other medical interventions including sympathetic nerve blocks.
Homeopathic/holistic treatment for RSD is another option patients may consider for pain and symptom management. As with traditional treatments, holistic treatments may need to be combined for optimal results.
Some of the homeopathic treatments that have been used successfully in RSD cases include massage (lymphatic massage is especially helpful to calm the nervous system without stimulating blood flow), acupuncture/acupressure (controls pain by inserting very thin needles into the skin for various amounts of time), physiotherapy (helps patients regain balance, flexibility, strength, and muscle mass), herbal medicines (ex. Dynamint: a mixture of peppermint, tee-tree oil, eucalyptus, and calendula-a muscle balm), and antioxidants/nutritional supplements (help to strengthen the immune system).
Gaining popularity as a homeopathic/holistic treatment for RSD, Qi Gong (pronounced "chee gong") is a treatment that employs simple exercises and slow movements to help rebalance the body's energy (Qi). Qi Gong masters are said to be able to transmit energy to others, thus improving their health.
Homeopathic/holistic treatment for RSD may be a viable option for those who have failed to see results with traditional medicine. However, as with all treatment options, homeopathic/holistic treatment for RSD should be evaluated by your doctor before you begin any program.
If you or someone you know needs an attorney regarding their RSD case, it is important that he or she understands RSD, it's causes, symptoms, and treatments, in order to provide you with the legal support you deserve. Attorneys are available to help you and to aid you in reclaiming your rights.