Complex regional pain syndrome (CRPS) is a condition that most commonly affects the hands but it can also occur in the arms, feet, and legs. The symptoms include spontaneous burning pain, muscle spasms, changing in skin color, swelling, and difficulty using the affected extremity.
CRPS has two types:
TYPE I – According to the Mayo clinic, ninety percent of CRPS cases are Type I which occurs after an injury or illness that didn’t directly damage or affect any nerves. For example, Type I could be triggered by a crushing blow or blunt force trauma to a limb.
TYPE II – A Type II CRPS onset occurs after an injury that directly affects a nerve such as cancer, a stroke, pressure on a nerve, a serious infection, or heart attack.
It is unknown why these injuries trigger CRPS. One of the more popular theories is that a “short circut” type of miscommunication happens between the central and peripheral nervous systems causing an inappropriate inflammatory response.
Three Stages of Complex Regional Pain Syndrome
Type I and Type II have different triggers but both types progress through three identical stages
Stage One: Acute Stage
Stage One can last up to three months and the dominate symptoms are intense burning pain, increased sensitivity to touch, spasms and excessive sweating. It is common for these symptoms to be followed by stiffness of the limb being affected by CPRPS and changes in hair and nail growth which is faster than normal.
Stage Two: Dystrophic Stage
Stage Two lasts anywhere from three to twelve months. The swelling remains constant, the joints stiffen, and the pain starts to worsen. Hair growth will slow down and the nails become brittle.
Stage Three: Atrophic Stage
Stage Three can start after a year and the changes that occur are irreversible. There may be a decrease in the level of pain but it can be felt in the entire limb and it remains constant. The limb also stiffens and the muscle starts wasting away. The area that has been affected by the disease becomes shiny due to the skin being tightly stretched and dry.
Treatment for CRPS
It is crucial that an early diagnosis is made so treatment can stop CRPS from advancing to the third stage which can be irreversible. Even though Complex Regional Pain Syndrome is not totally understood, it is treatable.
Medications: Corticosteroids and NSAIDs to reduce inflammation, various opioids and pain relief medications, muscle relaxers, anti-inflammatory drugs, antidepressants, and anticonvulsants are some of the recommended medications to relieve CRPS symptoms.
Injection therapy: If an early diagnosis is made, symptoms can be reduced by injecting a numbing anesthetic near the sympathetic nerves affected by CRPS. This can prevent the disease from advancing to the next stage.
Biofeedback: Pain relief can also be achieved through a combination of relaxation and body awareness programs.
Therapy: Normal patterns of active and passive movements of the affected limb are crucial in achieving permanent relief from CRPS and. Occupational and Physical therapy can play an important role in assisting patients returning to normal everyday use.
If the nonsurgical treatments fail, there are a few surgical options that may reduce CRPS symptoms.
Pain Pump: A compact medical device is implanted near the abdomen to administer pain relief medication. In some cases where the patient was incapacitated, a pain pump help restore quality of life.
Spinal Cord Stimulator: Small electrodes are placed in the epidural cavity of the spine which is controlled by a battery placed in the area of the abdomen. The patient can switch the battery on or off to administer small electric currents to interrupt the pain signals being sent by the nerves affected by CRPS.