Complex Regional Pain Syndrome - CRPS

DESCRIPTION
Formerly Known as Reflex Sympathetic Dystrophy (RSD)

Complex regional pain syndrome (CRPS) is a pain condition that is constant over a long period of time. It is believed to be the result of dysfunction in the central or peripheral nervous systems. It causes the nervous system to send frequent or constant pain signals to the brain. The nervous system becomes overactive, causing intense burning or aching pain, swelling, changes in skin color and moisture.

CAUSES

The causes of CRPS are not known. CRPS can begin after a minor injury, such as a sprain or small cut, or after major trauma or surgery. Injury to a nerve may also cause the condition.  It is most common among individuals between 25 and 55 years of age, though anyone of any age can be affected. CRPS is three times more likely to occur in women than men.  An estimated 60,000 Americans are affected by CRPS.

SIGNS AND SYMPTOMS

The key symptom of CRPS is continuous, intense pain. CRPS is often associated with the following symptoms:

  • "Burning" pain
  • Sensitive skin
  • Changes in skin temperature (warmer or cooler compared to other parts of the body)
  • Changes in skin color (often blotchy, purple, pale or red)
  • Changes in skin texture (shiny and thin, and sometimes excessively sweaty)
  • Changes in nail and hair growth patterns
  • Swelling and stiffness in affected joints
  • Decreased ability to move the affected body part

The pain may spread to include the entire arm or leg, even though the initial injury might have been only to a finger or toe. Pain can sometimes even travel to the other hand, arm or leg. It may get worse with emotional stress.

There is no single test to confirm that you have CRPS. The diagnosis is primarily through observation of signs and symptoms.  Patients must be examined by a qualified physician who does a thorough history and physical examination.  X-rays, MRI, EMG/NCV, bone scans, thermography, or pain imaging (where available) may be helpful.  You may need to visit another specialist, and a pain clinic is often recommended.

TREATMENT

The earlier the diagnosis of CRPS is made and treatment started, the better the chance for recovery.  Treatment is varied and depends on both the symptoms and amount of time that has passed. Exercise, treating possible sleep disorders, and treating possible psychological problems can be helpful for treatment. Since there is no simple cure for CRPS, treatment is intended to relieve painful symptoms so that patients can resume their normal lives and use their hands or arms normally.

Some CRPS treatments include:

  • Occupational/Physical Therapy: An increasing exercise program may help preserve or restore the function of your hand. Overall, exercise is very important to improve symptoms.
  • Psychotherapy: CRPS can have psychological effects on patients and their families. Many with CRPS have depression, anxiety or post-traumatic stress disorder. A psychologist or psychiatrist may be able to help with this issue.
  • Nerve Blocks: Many patients experience significant relief from this treatment. A nerve block is when an anesthetic is injected to numb the nerves. This can relieve pain, improve mood, and improve level of activity. An example of a stellate ganglion block is shown in Figure 1.
  • Medications: Many different drugs are used to treat CRPS and other conditions such as sleep disorders, depression and anxiety. Medications may include anti-seizure drugs, antidepressants, corticosteroids, muscle relaxants, and sleeping medications.
  • Surgery: If the CRPS is from a compressed nerve, such as with carpal tunnel syndrome, then surgery to release pressure on the nerve may be needed (e.g. carpal tunnel release).

Discuss your treatment options with your physician. Each patient with CRPS responds differently to treatment. Most physicians believe that early treatment is helpful to limit the disability from CRPS. More research is needed to understand the causes, the development of the disease, and how treatment can alter its course.


© 2012 American Society for Surgery of the Hand
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