Complex Regional Pain Syndrome
Complex Regional Pain Syndrome
Complex Regional Pain Syndrome (CRPS) is a chronic disease characterized by severe pain, swelling and changes in the skin. CRPS into two types based on the presence of nerve lesion following the injury.
Type I, also known as Reflex Sympathetic Dystrophy (RSD), Sudeck's atrophy, Reflex Neurovascular Dystrophy (RND) or Algoneurodystrophy, does not have demonstrable nerve lesions. Type II, also known as Causalgia, has evidence of obvious nerve damage.
Causes of Complex Regional Pain Syndrome
The cause of this syndrome is currently unknown. Precipitating factors include illness, injury and surgery, although there are documented cases that have no documentable injury to the place originally affected by complex regional pain syndrome.
Symptoms of Complex Regional Pain Syndrome
The symptoms of CRPS usually begin near the site of an injury, either major or minor, and usually spread beyond the original area. Symptoms may spread to involve the entire limb and, rarely, the opposite limb. The most common symptom is burning pain. The patient may also experience muscle spasms, local swelling, increased sweating, softening of bones, joint tenderness or stiffness, restricted or painful movement, and changes in the nails and skin.
The pain of CRPS is continuous and may be heightened by emotional stress. Moving or touching the limb is often intolerable. Eventually the joints become stiff from disuse, and the skin, muscles, and bone atrophy. The symptoms of CRPS vary in severity and duration. There are three variants of CRPS, previously thought of as stages. It is now believed that patients with CRPS do not progress through these stages sequentially and/or that these stages are not time-limited. Instead, patients are likely to have one of the three following types of disease progression:
Type one is characterized by severe, burning pain at the site of the injury. Muscle spasm, joint stiffness, restricted mobility, rapid hair and nail growth, and vasospasm (a constriction of the blood vessels) that affects color and temperature of the skin can also occur.
Type two is characterized by more intense pain. Swelling spreads, hair growth diminishes, nails become cracked, brittle, grooved, and spotty, osteoporosis becomes severe and diffuse, joints thicken, and muscles atrophy.
Type three is characterized by irreversible changes in the skin and bones, while the pain becomes unyielding and may involve the entire limb. There is marked muscle atrophy, severely limited mobility of the affected area, and flexor tendon contractions (contractions of the muscles and tendons that flex the joints). Occasionally the limb is displaced from its normal position, and marked bone softening is more dispersed.
No specific test is available for CRPS, which is diagnosed primarily through observation of the symptoms. However, thermography, sweat testing, x-rays, electrodiagnostics, and sympathetic blocks can be used to build up a picture of the disorder. Diagnosis is complicated by the fact that some patients improve without treatment. A delay in diagnosis and/or treatment for this syndrome can result in severe physical and psychological problems. Early recognition and prompt treatment provide the greatest opportunity for recovery. It is not usual for the course of this syndrome to change suddenly.
Treatment of Complex Regional Pain Syndrome
The general strategy in CRPS treatment is often multi-disciplinary, with the use of different types of medications combined with distinct physical therapies. The goal of treatment is to manage the symptoms and maintain or improve function of the affected area. The quicker the diagnosis is made and the area is treated, the more likely the problem is to go into remission.
Physicians use a variety of drugs to treat CRPS, including antidepressants, anti-inflammatories such as corticosteroids and COX-inhibitors such as piroxicam, vasodilators, GABA analogs such gabapentin and pregabalin, and alpha- or beta-adrenergic-blocking compounds.
Sympathetic blocks of the affected area can be helpful to decrease symptoms and allow more effective rehabilitation. These include lumbar sympathetic blocks, stellate ganglion blocks, and are some cases, sympathetic radiofrequency sympathectomy.
Neurostimulation (spinal cord stimulators) may also be surgically implanted to reduce the pain by directly stimulating the spinal cord. These devices place electrodes either in the epidural space (space above the spinal cord) or directly over nerves located outside the central nervous system. Implantable drug pumps may also be used to deliver pain medication directly to the cerebrospinal fluid which allows powerful opioids to be used in a much smaller dose than when taken orally.
Alternative treatments for complex regional pain syndrome include accupuncture or Ketamine therapy. Ketamine is a potent anesthetic, and is administered in different doses in an attempt to “reboot” the abnormal brain activity. These treatments are controversial, and some forms of Ketamine therapy are not approved for use in the United States.
Pain Relief Florida: Pinellas Park, Largo, St. Pete, Seminole, Clearwater, Dunedin, St. Pete Beach, Palm Harbor, Tarpon Springs, Safety Harbor, Macdill, Tampa, Bradenton, Palmetto, Parish and Sarasota.