Complex Regional Pain Syndrome

Complex Regional Pain Syndrome (CRPS) is a relatively uncommon (26 per 100,000 life-years with a 3.5-1 female to male ratio) chronic debilitating disease that typically causes pain in the extremities though there are cases where this can affect the entire body.  It is a diagnosis of exclusion, meaning that other sources of pain to that area must be ruled out prior to being diagnosed with this condition.  There are 2 types:  CRPS Type 1 and CRPS Type 2.  Type 1 is secondary to an injury/insult to an extremity.  This can occur after a mild injury such as a strain or soft tissue injury to occurring after a fracture or treatment of the fracture with immobilization.  Type 2 occurs after a specific nerve injury.  The majority of cases fall under Type 1.  The cause of the condition can be multifactorial involving pain mediators at the site of the injury as well as areas in and around your spinal cord.  Overactive nerves along the areas in the front of your spine can become sensitized.  Initially the nerves become activated after some type of insult.  At first, this serves a protective effect to allow healing of the area.  However, in some cases, these nerves continue to fire even after the area has healed.

Individuals will have significant pain more than what is to be expected from the injury.  In addition, the pain will continue beyond the time the injury should have already healed.  You may experience pain with even simple movements and/or pain from even the slightest of touch such as even air blowing over the area.  Additional symptoms specific to the affected area may include:  swelling, changes in skin color and temperature, increased/lack of hair growth and/or nail changes in the affected limb, unusual sweating in the arm/leg, cold sensitivity and weakness.  You may experience burning, shooting, stabbing sensations as well which also supports this diagnosis.

It is important to consider this diagnosis as a potential cause of pain early in the course of treatment especially if your pain continues after the injury heals and/or your pain is much higher than what is to be expected from the injury.  The reason is that the likelihood of curing this condition is based upon obtaining the appropriate treatment for the condition as early as possible.  The longer it takes to diagnose and finally treat the condition, the more likelihood that this will be a permanent condition.  If this is even considered as a possible cause of your symptoms, seek care from a board certified pain specialist immediately.

Initial treatment for this condition involves decreasing the pain as much as possible to allow you to be able to continue to use that extremity to avoid muscle/bone loss.  Medications can be used to help decrease the pain which normally involves anti-seizure medications to decrease the firing of the nerves causing your pain.  Antidepressants can also be used for this condition at low doses to help with pain and allow you to rest better.  In addition topical medications may be recommended.  Decreasing the pain to allow continued mobilization of the affected area is crucial to success.  Physical therapy in the form of desensitization can also be helpful to decrease the pain from this condition.  Unfortunately, none of the previous treatments address the underlying cause of the problem.  As mentioned earlier, the pain stems from a group of nerves along your spine that continue to send pain signals over and over again.  Similar to a computer that has gone haywire, the way to fix the problem is to “reboot the system” ie turn the computer off and allow it to restart again allowing it to return back to its normal function. How do we do this? By performing sympathetic blocks (see section) at the area in your spine responsible for causing your pain. As pain has memory, the sooner you undergo this procedure, the higher the chance your condition can be cured. More often than not, a series of these injections over a short period of time will become needed to “reset your system”. If this does not improve your condition, other more advanced minimally invasive surgeries may help decrease your pain by >50% without the use of oral “pain” medications.

(See spinal cord stimulation and intrathecal drug delivery systems)


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