Complex Regional Pain Syndrome
Complex Regional Pain Syndrome
An arm or Leg, mostly on one side, is usually affected by complex regional pain syndrome (CRPS), a kind of chronic sympathetic pain. CRPS is also known as Sudeck’s dystrophy, causalgia, and reflex sympathetic dystrophy. An immobilized limb or trivial trauma may result in this pain. Pain from CRPS can be excruciating.
Injuries, surgeries, strokes, heart attacks or surgery may cause this condition. In comparison with the severity of the original injury, the pain seems excessive.
Symptoms of this condition
In terms of severity and duration, CRPS symptoms differ.
- Pain, usually throbbing or burning, that lasts for a long time in your Leg or your Arm
- Cold or touch sensitivity
- Inflammation of the painful area
- Symptoms of the skin
- Alternating warm and cold temperatures of the skin
- The skin colour may change from white, blue or purple to red, blue or purple.
- Tenderness, thinning, or shiny skin in the affected area
- Excessively sweaty skin is sometimes seen in people with CRPS.
- Nail and hair growth changes
- A stiff, swollen, and damaged joint
- Spasticity, tremors, weakness, and atrophy (atrophy) of muscles
- The affected body part has a decreased range of motion
Note – Individual symptoms vary from person to person and from Time to Time. Symptoms and signs may disappear by themselves in some people. Some may experience symptoms for months or even years. Early diagnosis and treatment are likely to produce the best results.
What could be the possible causes?
- It is unclear what causes CRPS.
- In most cases, a fracture or trauma causes it.
- As well as surgeries, heart attacks, infections, even sprained ankles can cause these types of complications. The reason behind the onset of CRPS due to these injuries is not apparent.
Note- It is essential to keep in mind that not all those who have such an injury will develop it. The best way to understand your situation is by consulting with your doctor. In the case of new CRPS without apparent cause, a thorough evaluation is necessary to rule out any internal problems.
What Can Be Done-
- When sleeping or resting, CRPS sufferers should elevate their arms and legs to allow excess fluid to return to the heart.
- The best way to improve circulation and oxygenation is to exercise every day, even if it is only for a few minutes. A physical therapist can devise an exercise regimen.
- Some people may benefit from wearing compression stockings or sleeves when standing, mainly when swelling is present.
- It’s Important to See a Doctor and Get Advice
The Potential Consequences of Not Treating?
The disease can progress to more disabling symptoms and become more complicated if not diagnosed and treated early. Among them are:
- Atrophy (tissue wasting). When you avoid or are unable to move your Arm or Leg because of pain or stiffness, your skin, bones and muscles will deteriorate.
- Muscle contraction (tightening). Muscle tightening may also occur. You might develop a condition where your hand and fingers are fixed in one position.
Diagnosing Complex Regional Pain Syndrome?
Tests cannot identify the nerve-injured in CRPS and confirm the diagnosis. However, specific diagnoses include:
- Your doctor performs a detailed clinical examination.
- Blood tests are performed to rule out any infections in the body.
- A routine imaging test such as an X-ray, CT, or MRI helps identify the damaged nerve by detecting abnormalities in the bone or bone marrow.
- MRN (Magnetic resonance neurography) helps identify underlying nerve damage by imaging the nerves.
- CRPS-associated nerve injuries can be detected with nerve conduction studies, but not all. The test may not detect micro lesions.
- Diagnostic block of stellate ganglion for upper limb or lumbar sympathetic plexus for lower limbs will confirm the diagnosis and is usually followed by radiofrequency ablation of the respective sympathetic ganglion for long term relief.
The best early step in treating CRPS is to make a diagnosis as soon as possible, mainly because CRPS generally improves over time.
CRPS treatment: How does it work?
Early or mild cases are likely to recover on their own, but your doctor should be consulted. It is crucial to begin treatment as early as possible.
Among the most widely used therapies are:
Physical therapy and rehabilitation. Movement improves blood flow, decreases symptoms associated with circulatory problems, and maintains flexibility, strength, and function. Rehabilitation can assist people in returning to work and completing their everyday tasks.
Psychotherapy. Secondary psychological problems such as depression and anxiety are common in people with severe CRPS. Treatment of psychological issues helps sufferers recover from CRPS and feel better.
CRPS is commonly treated with the following drugs:
- Acetaminophen is used to relieve joint and bone pain associated with inflammation.
- Non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, and naproxen can manage moderate pain and inflammation if they are in sufficient amounts.
- Other drugs, including nortriptyline, gabapentin, pregabalin, duloxetine, and gabapentin, have proven effective for treating neuropathic pain.
- For those with the most severe pain, opioids such as oxycodone, morphine, hydrocodone, and fentanyl may be needed. It is essential to keep in mind that opioids may cause heightened pain sensitivity and lead to dependency.
Topical local anaesthetic ointments, sprays, or creams such as lidocaine and patches such as fentanyl. Using patches or other skin coverings can provide additional protection and reduce allodynia.
- Inflammation and swelling are treated with corticosteroids, including prednisolone and methylprednisolone.
- If the condition is severe, Botulinum toxin injections can help restore muscle tone to the hand or foot.
Spinal cord stimulation.
- In severe cases, a spinal cord stimulator may be necessary.
- Stimulating electrodes are positioned into the spine, outside the spinal cord.
- These Electrodes creates tingling sensations in the painful area, helps block pain perceptions and normalize brain and spinal cord signalling function.
- A few days of stimulation can be used to assess if electrodes will be helpful.
- To implant the stimulator, battery, and electrodes, minor surgery is required.
- By using an external controller, stimulators can be turned on and off.