Complex regional pain syndrome (or Reflex Sympathetic Dystrophy Syndrome)
Complex regional pain syndrome (CRPS) is a chronic pain condition affecting one of the limbs like the arm, leg, hand or foot, which develops after an injury, trauma or even surgery to that limb. Pain protects, but it can also cause harm if not controlled and managed. Pain is the number one reason patients come to see orthopaedic surgeons. To understand complex regional pain syndrome (CRPS), it is important to understand a few basic principles about pain.
Pain is controlled by a complex system where the original pain receptor sends a signal to the brain via the nerve cells (synapses) to the areas in the brain responsible for sensation, thought, and emotions. The sensation of pain is managed by several different control systems and is affected by emotional status, previous experiences, expectations and fear. The central nervous system includes the brain and spinal cord while the peripheral nervous system includes the signalling nerves in the brain, which communicate to the rest of the body. Complex regional pain syndrome (CRPS) is believed to be caused by damage to, or malfunction of, the peripheral and central nervous systems.
Symptoms of complex regional pain syndrome (CRPS)
- severe and prolonged pain after injury, 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
There are two types of complex regional pain syndrome (CRPS):
Type 1:
this type, also known as reflex sympathetic dystrophy syndrome, occurs after illness or injury that did not directly affect the nerves in your affected limb. It is by far the most common type of CRPS
Type 2:
this type occurs after a distinct nerve injury to the affected limb. Emotional stress may also be a precipitating factor.
Diagnosis of complex regional pain syndrome (CRPS) or Reflex Sympathetic Dystrophy Syndrome
There are no specific tests to confirm the diagnosis. Usually, prolonged excessive pain in a limb where there was previous injury or surgery is enough evidence for a diagnosis of complex regional pain syndrome (CRPS).
Treatment options for complex regional pain syndrome (CRPS)
CRPS seems to respond better to early intervention, but the results vary. Left untreated chronic pain due to CPRS can be debilitating, and in rare cases, it can cause irreversible dysfunction of the limb. Medications such as analgesics (paracetamol, opioids), non-steroidal anti-inflammatory drugs, certain anti-depressants (amitriptyline) and gabapentin or pregabalin can be beneficial to ease the symptoms of CRPS. Exercise may also help trigger the body's natural pain killers (enkephalin, endorphin and dynorphin). Hot and cold treatments and massages may also help. In severe cases, sympathetic regional blocks with Bupivacaine and Celestone Soluspan can help reduce the symptoms.
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.