Complex Regional Pain Syndrome (CRPS) is a chronic pain condition most commonly affecting the arms or legs and is estimated to impact approximately 200,000 people in the United States. This condition arises from damage or malfunction of the nervous system, leading to intense and disproportionate pain. Individuals with CRPS may also experience skin temperature, color, texture, swelling, and limited mobility changes. The debilitating nature of CRPS significantly affects daily life.
Complex regional pain syndrome self-care strategies such as low-impact exercise, stress management, adaptive equipment, and personalized treatment plans are crucial in effectively managing symptoms and enhancing overall well-being. Early diagnosis and timely treatment combined with diligent self-care empower individuals with CRPS to take control of managing their condition.
Symptoms of CRPS
The main symptom of CRPS is severe, continuous, debilitating pain, often described as burning or throbbing. It involves nervous system dysfunction and can occur without a trigger. Additional symptoms include numbness, tingling, increased sensitivity to touch, and temperature changes, leading to pain from minor injuries or light touches. Pain is often disproportionate to the expected pain after trauma. Other symptoms include skin/nail/hair changes, swelling, weakness, and limited mobility. Stiffness, limited range of motion, muscle weakness, and muscle atrophy can occur over time.
Symptoms vary between individuals and can change over time. Some people experience skin color, texture, and temperature changes in the affected limb. Seeking medical attention for proper diagnosis and treatment is vital if experiencing these symptoms. Early diagnosis is paramount.
Causes of CRPS
There is still much to learn about CRPS as it is not fully understood. Generally, CRPS is divided into two categories: type 1 and type 2.
Complex Regional Pain Syndrome Type 1, historically known as reflex sympathetic dystrophy, is typically related to trauma without a clear nerve injury.
Complex Regional Pain Syndrome Type 2, historically known as causalgia, typically follows a clear nerve injury such as surgery. It shares similar symptoms as Type 1, but is distinguished by definable nerve damage as the cause.
Key contributing factors include sympathetic and somatic nervous system dysfunction, neurogenic inflammation, hypoxia, and psychological factors. It is believed initial injury or trauma triggers abnormal sympathetic nervous system activity, resulting in reduced blood flow and decreased oxygen delivery. This leads to tissue damage and amplified pain signals. Inflammatory mediators released from injured nerves also increase pain sensitivity. Psychological factors like stress and anxiety may influence pain perception.
The complex interplay between these factors perpetuates symptoms, though more research is needed on CRPS development mechanisms.
Complex Regional Pain Syndrome Stages
CRPS has been described as having two main stages: the acute (warm) stage, characterized by symptoms of inflammation, such as warmth and swelling, and the chronic (cold) stage, characterized often by trophic changes of the soft tissues. The acute phase typically presents with severe neuropathic pain, with a range of motion limitation and swelling/skin changes. The chronic phase presents with muscle atrophy, stiffness, and even contractures. Without treatment, CRPS can lead to severe debility.
Diagnosis
Diagnosis of CRPS is purely clinical, meaning no blood tests or imaging findings can diagnose it. It involves meeting established diagnostic criteria of disproportionate continuing pain and other sensory, motor, vasomotor, and trophic changes. Patient history and physical exams evaluating these changes are necessary. The most important diagnostic criterion is that there is no other condition or syndrome that could explain the current symptoms
Key imaging tests like X-rays and bone scans identify bone abnormalities and inflammation. Nerve conduction studies also assist in the diagnosis of CRPS Type 2. While not definitive, lab tests analyzing sensory, motor and autonomic function provide supplemental diagnostic information. However, more research on these diagnostic studies’ predictive value is needed. Combining a thorough history, physical examination, imaging studies, and lab tests allows providers to identify the characteristic signs of CRPS to guide proper treatment.
Treatment Options
Treatment of CRPS is multifaceted due to the varying symptoms. Physical and occupational therapy are first-line therapies to improve the range of motion and avoid kinesiophobia. Physical and occupational therapy can improve mobility, strength, function, and coping skills. Sympathetic nerve blocks provide temporary pain relief for CRPS.
Medications are a key component in treating CRPS pain and symptoms. Seeing as though CRPS is primarily a neuropathic pain syndrome, medications aimed to treat nerve pain are prescribed early, such as anticonvulsants such as gabapentin, tricyclic antidepressants, and serotonin-norepinephrine reuptake inhibitors. Steroids may also be employed to target some of the inflammatory-mediated pain. Other medications and supplements that may be implemented include topical lidocaine or lidocaine patches, vitamin C, or a medication class called bisphosphonates. Opioids may be used short term but have risks.
In severe cases, spinal cord stimulation with implanted electrodes may be used.
Since responses vary, individuals must work closely with providers to tailor the CRPS treatment plan to their needs and goals. There is no one-size-fits-all approach to the treatment of complex regional pain syndrome.
Close provider supervision is crucial to tailor the complex regional pain syndrome medication regimen to the individual’s needs, monitor side effects, and find the most effective medication combinations. While not curative, complex regional pain syndrome medications can significantly improve symptoms when thoughtfully managed.
Complex Regional Pain Syndrome Self-Care
Complex regional pain syndrome self-care is vital for managing symptoms and improving well-being. Regular low-impact exercise, pain management techniques, physical therapy, stress management, healthy lifestyle choices, and assistive devices can all help minimize CRPS pain, promote circulation and mobility, and make daily activities easier. Discussing self-care strategies with healthcare providers allows tailored plans to empower individuals to control their CRPS actively.
Emerge Stronger. Healthier. Better.
For individuals living with CRPS, seeking appropriate care and treatment is paramount. With our team of dedicated interventional pain management experts, EmergeOrtho-Triangle Region understands the challenges faced by CRPS patients and is committed to providing comprehensive care that focuses on merging stronger, healthier, and better.
EmergeOrtho strives to alleviate pain, enhance functionality, and improve the overall quality of life for individuals battling CRPS through specialized therapies, personalized treatment plans, and advanced interventions. We are here to support and guide patients on their journey toward recovery and empowerment. To seek treatment for CRPS, we encourage you to schedule an appointment. Or, call us any time at (919) 220-5255.
