Complex Regional Pain Syndrome

Complex regional pain syndrome (CRPS) is a form of chronic pain that usually affects an arm or a leg. CRPS typically develops after an injury, a surgery, a stroke or a heart attack. The pain is out of proportion to the severity of the initial injury.

What are the symptoms of CRPS?

  • Continuous burning or throbbing pain, usually in your arm, leg, hand or foot
  • Sensitivity to touch or cold
  • Swelling of the painful area
  • Changes in skin temperature, skin color, and skin texture
  • Joint stiffness, swelling and damage
  • Muscle spasms, tremors, weakness and loss (atrophy)
  • Decreased ability to move the affected body part

Symptoms may change over time and vary from person to person. Pain, swelling, redness, noticeable changes in temperature and hypersensitivity (particularly to cold and touch) usually occur first.

In some people, signs and symptoms of complex regional pain syndrome go away on their own. In others, signs and symptoms may persist for months to years. Treatment is likely to be most effective when started early in the course of the illness.

What causes CRPS?

The cause of complex regional pain syndrome isn’t completely understood. It’s thought to be caused by an injury to or an abnormality of the peripheral and central nervous systems. CRPS typically occurs as a result of a trauma or an injury.

Complex regional pain syndrome occurs in two types, with similar signs and symptoms, but different causes:

  • Type 1. Also known as reflex sympathetic dystrophy syndrome (RSD), this type occurs after an illness or injury that didn’t directly damage the nerves in your affected limb.
  • Type 2. Once referred to as causalgia, this type has similar symptoms to type 1. But type 2 complex regional pain syndrome follows a distinct nerve injury.

What is the treatment for CRPS?

There’s some evidence that early treatment, within the first few months of symptoms, might help improve complex regional pain syndrome symptoms. Often, a combination of different treatments, tailored to your specific case, is necessary. Treatment options include:

Medications

  • Pain relievers. Over-the-counter (OTC) pain relievers — such as aspirin, ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) — may ease mild pain and inflammation.
  • Antidepressants and anticonvulsants. Sometimes antidepressants, such as amitriptyline, and anticonvulsants, such as gabapentin (Neurontin), are used to treat pain that originates from a damaged nerve (neuropathic pain).
  • Corticosteroids. Steroid medications, such as prednisone, may reduce inflammation and improve mobility in the affected limb.
  • Bone-loss medications. Your doctor may suggest medications to prevent or stall bone loss, such as alendronate (Fosamax) and calcitonin (Miacalcin).
  • Sympathetic nerve-blocking medication. Injection of an anesthetic to block pain fibers in the affected nerves may relieve pain in some people.

Therapies

  • Heat therapy. Applying heat may offer relief of swelling and discomfort on skin that feels cool.
  • Topical analgesics. Various topical treatments are available that may reduce hypersensitivities, such as over-the-counter capsaicin cream, or lidocaine cream or patches.
  • Physical therapy. Gentle, guided exercising of the affected limbs might help decrease pain and improve range of motion and strength. The earlier the disease is diagnosed, the more effective exercises might be.
  • Transcutaneous electrical nerve stimulation (TENS). Chronic pain is sometimes eased by applying electrical impulses to nerve endings.
  • Spinal cord stimulation. Your doctor inserts tiny electrodes along your spinal cord. A small electrical current delivered to the spinal cord results in pain relief.
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