Understanding complex regional pain syndrome (CRPS, RSD)

Complex regional pain syndrome (CRPS) is a chronic pain condition. CRPS is also known today as reflex sympathetic dystrophy (RSD) and was known in the past as causalgia. The often-excruciating and non-stop “burning” pain of CRPS may be triggered by any injury, such as surgery, broken bones, or car accidents. Even minor injuries like sprains may lead to overwhelming CRPS pain.

The calling card of CRPS is pain that keeps “reliving” the pain of the original injury, even though it seems like normal healing has already taken place. In addition to having severe pain, it’s common for the “healed” area to still have redness, swelling, and throbbing. Without early treatment, this pain may keep building; it could even spread to other parts of the body. For example, pain may begin in a person’s finger, but spread up the person’s arm to his shoulder. This type of pain doesn’t go away with time, like it should with a normal injury.

CRPS affects up to 1.2 million Americans, and two to three times more women than men get the condition. Although the cause is not fully understood, experts feel that CRPS is due to a problem with the nervous system – sort of like an electrical “short-circuit.” It may start with an injury to a single, small nerve fiber, but in many cases, the damaged nerve is never found. Once the nerve has been “hurt,” pain messages between the brain and that part of the body go into overdrive: nerve endings fire too often, causing a person to feel severe amounts of pain. When (or if) the overtaxed nerve finally “burns out,” other neighboring nerve fibers may try to fill the gap by sending their own pain messages to the brain. The result is pain that spreads and spirals out of control.

As we’ll see, other symptoms can add to the pain that people feel with CRPS: There may also be redness and swelling in the area of the body that has been hurt.

The symptoms of CRPS

Most people with CRPS are treated by a pain specialist, a type of healthcare provider who helps people with chronic pain. Because there are no special tests to help diagnose a case of CRPS, these doctors must pay close attention to the health problems that their patients report.

For example:

  • The skin may be unusually and unbearably sensitive to touch.
  • The skin temperature of the affected area will often be warmer than the rest of the body.
  • The skin may look smooth and shiny and/or blotchy, purple, pale or red.
  • There may be unusual amounts of sweating and/or swelling in the affected area(s).
  • Nearby joints may be stiff and/or swollen.
  • Any nails or hair in the affected area(s) may grow more quickly at first and then become brittle and break off, leaving the skin hairless and even shiny.

Healthcare providers usually only arrive at a diagnosis of CRPS if they’re able to rule out other conditions that have similar symptoms.

Treating CRPS

CRPS can be hard to treat. Experts feel that the best results come from using a combination of different types of therapy, along with medication to control the pain and reverse the condition. Options include:

  • Physical therapy to help CRPS sufferers move around more easily
  • Occupational therapy to help people adapt to their home and workplace in spite of their physical problems
  • Psychological therapy (usually cognitive-behavioral therapy) to help patients learn better ways to respond to and handle their pain
  • Medication and other pain-relieving options:
    • Standard pain medications, like non-steroidal anti-inflammatories (e.g., NSAIDS like ibuprofen) or opioids (e.g., hydrocodone or morphine)
    • Anti-seizure medications like gabapentin; these medications may help with pain even if a person doesn’t have seizures
    • Biophosphonates or calcitonin to treat bone pain
    • Ketamine, an anesthetic that’s being tested in CRPS patients as a long-term treatment
    • Spinal cord stimulation, where a small electrical device in the spine helps to block pain messages from reaching the brain

CRPS can be a very trying and painful condition, but early diagnosis, aggressive treatment, and a strong support system can make it easier to manage.

References

Reflex Sympathetic Dystrophy Syndrome Association (RSDSA)
http://www.rsds.org

American RSDHope Organization
http://www.rsdhope.org

National Institute of Neurological Disorders and Stroke (NINDS)
http://www.ninds.nih.gov   (search on “CRPS”)

International Research Foundation for RSD / CRPS
http://www.rsdfoundation.org

Mayo Clinic
http://www.mayoclinic.com   (search on “CRPS”)