Complex Regional Pain Syndrome

Complex regional pain syndrome, or CRPS is severe pain lasting more than 6 months. CRPS usually affects an arm or a leg, but can affect any body part. CRPS is most often an abnormal response that magnifies the effect of an injury. It can happen after heavy trauma such as a broken bone, loss of limb, or a crushed limb. Sometimes the pain begins after a surgery, sickness, infection, or other medical problem. Doctor’s aren’t sure how CRPS is caused, but they think it might happen because of a malfunction of the nervous system (the brain, spine, sensory organs, and nerves in the body).

The pain is usually a burning feeling, and the amount of pain is worse than what is expected after an injury. On top of chronic arm or leg pain, there may be abnormal inflammation [in-fluh-MAY-shun] or nerve dysfunction [dis-FUHNK-shun].

Symptoms can also change over time or spread to other body parts. For instance, if you have CRPS in their right arm, the pain could also hurt the left arm. CRPS can be made worse by stress. Rest and time may not help the symptoms.

There is not cure for CRPS, but treatment can improve the symptoms. Children and teenagers can expect better outcomes than adults.

For a few people, CRPS can go away on its own, either for a while or for good. Sometimes stress or exposure to cold can cause CRPS to come back. For many people who don’t get treatment, the hurt body part can change in ways that can’t be reversed. This can include:

• Cold and pale body part
• Skin and nail changes
• Muscle spasms
• Muscle tightness

CRPS is can happen to anyone, but is more common in women. It is rare in children under age 5, and slightly less rare in children under age 10.

The symptoms of CRPS in the affected body part include:

• Severe pain that doesn’t go away and gets worse over time
• Burning, sharp, or throbbing pain that is very bad
• Fast changes in the skin’s temperature (cold and then hot and sweaty)
• Changes in the skin’s color (white and blotchy to red, purple, or blue)
• Changes in the skin’s texture (tender or thin and shiny)
• Changes in hair and nails
• Greater sensitivity, mostly to touch or cold
• Swelling of the area
• Not being able to move the hurt part as well or at all
• Tremors or jerking that you cannot control

Because the hurt nerves cannot do their job right, you may have problems with blood vessels, bones, muscles, nerves, and skin. Symptoms may change over time, and your symptoms may be different from others with CRPS.

CRPS stages

CRPS often progresses through stages.

• Stage 1. Most of the time, the signs that show up in the first one to three months are:
• Severe pain
• Swelling
• Skin color changes (blotchy, purple, red, or pale)
• Skin texture changes (thin and shiny)
• Changes in the skin’s temperature (hot or warm to cold and back to hot)
• Painful sensitivity to touch and cold
• Faster growth of nails and hair
• Stage 2. Stage 2 lasts three to six months. It is marked by:
• Worse pain than in Stage 1
• More changes to the skin
• Cracked or broken nails
• Slower hair growth
• Stiffness
• Weakness
• Stage 3. In Stage 3, changes that cannot be undone might happen. Signs that mark this stage include:
• Severe pain
• Pain that has spread
• Low movement in the limb (contracture [kun-TRAHK-shur])
• Muscle wasting (atrophy [AT-row-fee])

Other problems

If left untreated, CRPS can lead to serious problems, such as:

• Tissue wasting (atrophy). If you won’t move his hurt limb because of pain or stiffness, their skin, bones, and muscles will weaken.
• Muscle tightening (contracture). You muscles may contract to where they are locked into a position that is not normal.

Other problems that having CRPS can cause include:

• Problems with thinking
• Depression
• Anxiety
• Loss of muscle in the hurt body part
• Spread of CRPS to another body part
• More pain and other signs in the hurt body part

You should see a doctor if:

• You have constant pain in an arm, leg, hand, or foot
• Your pain makes it very hard to move or touch the hurt body part

Early diagnosis and treatment are very important with CRPS.

Doctors aren’t always sure what causes CRPS, but it might be a malfunction of the nervous system (the brain, spine, sensory organs, and nerves in the body).

CRPS can happen after you are hurt. Many cases involve heavy trauma such as a broken bone, loss of limb, or a crushed limb. Sometimes the pain begins after a surgery, sickness, or other medical problem.

CRPS can be split into two kinds:

• CRPS Type 1 happens after sickness or injury that does not directly hurt the nerves in the body part with CRPS. Most people get Type 1. It is sometimes called reflex sympathetic dystrophy syndrome.
• CRPS Type 2 happens after the nerves of the body part with CRPS are hurt. Type 2 used to be called causalgia.

A diagnosis of CRPS is based on signs and symptoms. There is no specific test for CRPS. Your doctor will do a physical examination and check your medical history.

Your doctor might order tests to check for CRPS symptoms, including:

• Thermography [thur-MAH-gruh-FEE], a test that shows changes in temperature and blood flow)
• Bone scan
• Nerve conduction study (NCS)
• X-ray
• MRI

While there is no cure for CRPS, treatment can slow symptoms. Treatment should be started early for the best results.

Any treatment plan is centered on easing the pain. The goal is to relieve youpain so you can live as normally as possible.

A treatment plan that works for one person may not work for another. Most treatments include medicine and therapy (such as physical therapy and psychotherapy). On top of the treatment plan the doctor orders, it is important that you gets to get the rest that you need and manage stress.

Medicines

Many medicines can be used to treat CRPS. All medicines can have side effects. If you have dizziness, drowsiness, a fast heartbeat, or other problems, you should call your doctor.

• Over-the-counter (OTC) pain medicine such as aspirin, ibuprofen, and naproxen may help with pain and swelling.
• Prescription pain medicine, such as opioids. For the most severe pain, OTC medicines might not work. Opioids may be used very carefully to give relief from pain. Opioid medicines carry risk of dependence and addiction, so it’s important to talk with your doctor about your personal risk factors.
• Antidepressants and anticonvulsants. These may be used to treat pain from a hurt nerve.
• Corticosteroids. A steroid medicine may lessen swelling and help with movement.
• Bone-loss medicine. This can help to prevent or lessen bone loss.
• Sympathetic nerve-block. This is an injection that can help to ease pain by numbing nerves with an anesthetic [ann-ess-THEH-tik].
• Topical anesthetic. These are creams and patches that numb the skin.

Therapy

• Physical therapy exercises can ease pain. They also help with movement and strength.
• Psychotherapy can help with depression and anxiety.
• Applications of cold (to ease swelling and sweating) and of heat (when the area is cold) can help with pain.
• Biofeedback can help you learn to relax, which can help with pain.

Surgery

A surgery called surgical sympathectomy [sim-puh-THEK-tuh-mee] can be used to treat CRPS. A surgeon will cut or clamp the nerves that are hurt, which might provide pain relief. Sometimes this surgery will make CRPS worse.

Minor surgery may be needed to place electrodes for neural stimulation (such as spinal cord stimulation) therapy that relieves pain.

No one can say when an injury or illness will lead to CRPS. Staying safe and healthy gives some protection.

Studies show that taking Vitamin C after a wrist fracture (broken bone) might also help prevent CRPS.

Complex regional pain syndrome, or CRPS, is long-lasting, severe pain, usually in an arm or a leg. CRPS can affect any body part and is sometimes the result of trauma such as a broken bone. CRPS affects the nervous system and cause changes in the skin and muscles.

There is no cure for CRPS. Treatment is centered on easing the pain. Most treatments include medicine, physical therapy, and psychotherapy. Treatment works best when started early.