20 Mar Overview of CRPS from a Maryland Pain Clinic
Complex Regional Pain Syndrome
Complex regional pain syndrome (CRPS) is a chronic pain condition. It causes extreme pain which usually subsides in the hands, arms, legs, and/or feet. Usually, CRPS occurs after an injury to either a nerve or tissue in the surrounding area. Time and rest can help the condition. There isn’t a cure for CRPS, and it can get worse over time. The pain can spread to other parts of the body, but sometimes it will go away either temporary or all together.
Of note, CRPS is also known as RSD, which is short for Reflex Sympathetic Dystrophy. People use the terms interchangeably.
Is CRPS common?
In the Rochester Epidemiology Project, records from the Mayo Clinic and Olmsted Medical were evaluated. Researchers found that the annual incident rate of Complex regional pain syndrome was 5.46 per 100,000 person years at risk. Also, the prevalence rate was 20.5 per 100,000. The condition appeared to be more common among women, with a female-to-male ratio of 4:1. The median age at onset for CPRS was 46 years, and the upper limbs were affected twice as often as the lower ones. Common triggers were an antecedent event or fracture, and 74% of patients underwent resolution, which was usually spontaneous.
What causes CRPS?
Because of a reaction in the sympathetic nervous system (SNS), CRPS may develop following an injury, major trauma, or complex surgery. The SNS is part of the autonomic nervous system (ANS), which regulates heart rate, respiration rate, digestion, perspiration, and salivation. The SNS balances the body’s resources under stress, which causes the “fight or flight” response. During dangerous situations, the SNS accelerates the following:
- Heart rate
- Breathing rate
- Levels of certain hormones (adrenaline)
- Blood pressure
Vital signs will rise during stress or danger, preparing the body for a sudden, short-term burst of energy so a person can run faster or fight better. Trauma, such as a physical injury, causes the SNS to release the “fight or flight” hormones known as catecholamines, which is one common theory of CRPS cause. Certain people have an unknown underlying problem, which causes catecholamines to activate pain receptors (the nerve endings that send pain signals to the brain). So, many people with this condition so not have pain from the actual injury, but rather, from the way the body has responded to it.
What are the symptoms associated with complex regional pain syndrome?
Symptoms occur in the affected area with complex regional pain syndrome. Common signs and symptoms are:
- Intense burning pain
- Odd changes in color, skin temperature, and texture of skin.
- Stiffness and/or swelling in affected joints
- Decreased ability to move affected body parts
- Extremely sensitive skin
How is CRPS diagnosed?
Once you seek medical advice, and CRPS is suspected, the doctor will ask about your medical history, look for swollen joints, and assess for changes to skin temperature and appearance. After performing a comprehensive physical examination, there are several diagnostic tests for CRPS. These include:
- SNS catecholamine test, which can identify possible anomalies.
- A special type of camera is used for a bone scan to look for increased circulation to the joints in the affected area.
- Thermography, which measures skin temperature of specific parts of the body. Different temperatures in the affected area could indicate CRPS.
- A sweat test, which will help the doctor see if the affected body part produces more sweat than the unaffected body part.
- X-rays, which are used to detect mineral loss in the bones at later stages of CRPS.
- Electrodiagnostic testing, which involves attaching wires to the skin and measuring electrical activity of nerves.
- MRI scans, biopsy of muscle tissue, or a blood test can rule out problems with tissue and bones.
How is CRPS treated?
The most effective treatment for CRPS is early detection, which may help to get rid of any signs or symptoms. A specialist such as a neurologist and physical therapist may help in treating CRPS. The range of movement and coordination of the affected extremity can be regained by physical therapy. It also helps to prevent contortion of bones and prevent muscle wastage.
Occupational therapy is important to determine how CRPS is impacting a patient’s daily life. The occupational therapist is able to prescribe assistive devices. In addition, a psychologist will help patients with CRPS to cope with their chronic, painful condition.
With regards to pain management, medications may help for CRPS. This may includes NSAIDS, opiates, neurogenic medications like Lyrica, or anti-depressants. In addition, there are several options for interventional pain treatments. This may include sympathetic blocks for the lower extremities, or stellate ganglion blocks for the upper extremities.
For pain that doesn’t respond adequately, then a spinal cord stimulator may be the answer. The implant is typically very effective for relieving pain. While it doesn’t cure the problem, it may mask the pain very effectively, allowing people to get back to work, recreational activities and socializing.
All Star Pain Management offers effective and comprehensive treatment for CRPS. Most insurance is accepted and there are 2 pain clinics in Annapolis MD and Glen Burnie as well. Call today for top treatment!