Complex regional pain syndrome or (Reflex Sympathetic Dystrophy)

Complex regional pain syndrome (CRPS) is a chronic pain condition affecting one of the limbs (arms, legs, hands, or feet), usually after an injury (major or minor), trauma or even surgery to that limb.


To understand this condition it is important to understand a few basic principles about pain.


Pain protects and does not kill, but it can also cause harm if not controlled and managed. Pain is also the reason why majority of patients consult doctors and especially Orthopaedic Surgeons. Pain is controlled by a complex system where the original pain receptor sends a signal to the brain via nerve cells and connections between nerve cells (synapses) to the frontal (thinking) somatosensory (sensation) and to limbic system (emotions).


The sensation of pain is controlled by several different control systems and is affected by emotional status, previous experiences, expectations, fear etc.There are natural methods to improve pain by using the body’s own pain killers (enkephalin, endorphin and dynorphin) through exercise.

Complex Regional Pain Syndrome or Reflex Sympathetic Dystrophy

CRPS is believed to be caused by damage to, or malfunction of, the peripheral and central nervous systems. The central nervous system is composed of the brain and spinal cord, and the peripheral nervous system involves nerve signalling, from the brain and spinal cord to the rest of the body.


CRPS is characterized by prolonged or excessive pain and mild or dramatic changes in skin colour, temperature, and/or swelling in the affected area.


Type 1. Also known as reflex sympathetic dystrophy syndrome, this type occurs after an illness or injury that didn't directly damage the nerves in your affected limb. It is by far the most common type of CRPS.


Type 2. this type follows a distinct nerve injury. Emotional stress may be a precipitating factor, as well.


It's not well-understood why these injuries can trigger complex regional pain syndrome, but it may be due to a dysfunctional interaction between your central and peripheral nervous systems and inappropriate inflammatory responses.

Symptoms of CRPS

  • Severe prolonged pain after trauma or surgery to a limb.
  • changes in temperature, skin colour, and swelling of the affected limb.
  • abnormal sweating .
  • changes in nail and hair growth patterns.
  • joint stiffness and muscle stiffness.

Diagnosis of CRPS

High index of suspicion with prolonged excessive pain where this was a previous injury or surgery to a limb,there are no specific tests to confirm the diagnosis.


In severe cases X-ray appearance will be of moth eaten osteoporosis and MRI changes can develop.


Treatment of CRPS

Medication:

  • Analgesics (paracetamol, opoids).
  • Non-steroidal anti-inflammatory drugs.
  • Anti depressants (amitriptyline).
  • Gabapectin, pregabalin.

Exercise:

  • Heat and cold treatment and massages.
  • Sympathetic Regional blocks with Bupivacaine and Celestone Soluspan.

Prognosis:

CRPS seem to respond better to early intervention and the results are very variable, it can lead to deblilitating chronic pain and irreversible debilitating dysfunction of the limb in small rare cases.

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