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Jose G. Veliz, M.D. M.S.A.
Medical Director
Palomar Pain Management Center
Pomerado Pain Management Center
Posted May 2, 2008 3:13 PM
 Complex Regional Pain Syndrome (CRPS), also called reflex sympathetic dystrophy, is continuous, intense pain which is out of proportion to the injury severity. It is most common in people aged 20-35. It does occur in children. Women are more likely to be inflicted with CRPS than men. It can occur at any age and treatment is most effective when begun early in the course of the syndrome. There is no cure for CRPS however symptoms can be greatly improved by aggressive treatment.
There are two types of CRPS. Both types have similar signs and symptoms but the causes are different. Type one occurs after an injury or illness that did not directly injure or damage the nerves and the affected limb. Type two occurs after a distinct nerve injury. Examples of injuries or illnesses which can result in CRPS include infections, improperly placed splints or casts, primarily neurologic problems such as carpal tunnel syndrome, fractures, sprains, heart attacks, surgery and forceful trauma such as gun shoot wounds or explosions.
CRPS may be a result of dysfunction in the central or peripheral nervous systems. The sympathetic nervous system may also play an important role in CRPS. Other theories include an intense immune response leading to classic inflammatory symptoms of swelling, warmth, and redness in the affected area.
Signs and symptoms include:
- Swelling and stiffness in affected joints
- Skin sensitivity
- Burning pain
- Changes in hair and nail growth
- Decreased ability to move the affected body part
- Changes in skin temperature the skin in one extremity may feel cooler or warmer compared to the opposite extremity.
- Changes in color. The skin may appear red, pale, purple, or blotchy.
CRPS may result in continuous, intense pain that is out of proportion to the severity of the injury. Even if the original injury occurs in a finger or toe, pain can spread to include the entire leg or arm. In many cases, pain can even extend to the opposite extremity.
CRPS may be diagnosed by your doctor first by performing a medical history and physical examination. Other tests include triple phase bone scans, x-rays, MRIs, and sympathetic nervous system tests including thermography and tests which measure the production of sweat in both limbs.
The three basic measures in therapy include pain management, rehabilitation (including physical therapy), and psychological therapy if needed. Treatments include sympathetic nerve block, physical and or occupational therapy, and spinal cord stimulation. Medications include topical analgesics, low dose narcotics, anti-depressants, and anti-seizure drugs. Anti-seizure drugs include gabapentin and Lyrica (pregabalin). Anti- depressants include Cymbalta (duloxetine) and tricyclic anti-depressants. Bio feedback is also a treatment to relieve painful symptoms. Biofeedback involves becoming more aware of your body so that you can relax your body and relieve pain. Applying heat is another method to relieve painful symptoms. Electric hand and foot warmers are effective however, it is important that a barrier be placed between the skin and the heating object in order to avoid burns. Some experts believe that applying cold may be effective in relieving painful symptoms. This is a controversial area and it is my belief that cold should be avoided as it may exacerbate the painful symptoms of CRPS. Pain can also be diminished by reducing swelling. Ways to reduce swelling include elevation above heart level and this is easier when CRPS involves the hands. When CRPS involves the lower extremities elevating above heart level will require the individual to lay on his back in order to raise his lower extremity above heart level. Another effective way of decreasing swelling is by using upper or lower extremity edema gloves. These gloves apply light pressure but can be very affective in decreasing the amount of swelling. Living with the painful symptoms of CRPS on a daily basis can be emotionally challenging as well. Support groups allow you to share experiences with other individuals experiencing similar symptoms. It is important not to hide your feelings or emotions from your doctor. Behavioral phycologists or therapist may very helpful as well. Organizations such as www.rsds.org and www.rsdfoundation.org can provide important information as well as support.
References:
Mayoclinic.com, webmd.com, emedicine.com, and the NINDS Complex Regional Pain Syndrome Information Page.
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