Complex regional pain syndrome (CRPS)
Complex regional pain syndrome (CRPS) is a chronic pain condition predominantly affecting the limbs, characterized by prolonged and severe pain that may manifest as burning sensations or a feeling of pressure. It is categorized into two types: CRPS 1, which occurs without confirmed nerve injury, and CRPS 2, where there is a specific nerve injury involved. Commonly triggered by trauma such as fractures, sprains, or even minor procedures, CRPS can result in symptoms like swelling, changes in skin color, and temperature fluctuations in the affected area. The underlying causes of CRPS are linked to abnormalities or damage within the peripheral and central nervous systems, though not all individuals with injuries develop this syndrome. Treatment typically involves a combination of physical therapy, medication, and potentially surgical options aimed at alleviating symptoms and improving mobility. Additionally, addressing mental health aspects is crucial, as conditions like anxiety and depression may exacerbate the experience of pain. Overall, CRPS presents significant challenges, and a multidisciplinary approach is often necessary for effective management.
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Complex regional pain syndrome (CRPS)
Complex regional pain syndrome (CRPS) is a medical condition characterized by chronic pain that commonly affects the limbs of the body. It is divided into CRPS 1 (no confirmed nerve injury) and CRPS 2 (confirmed nerve injury). This condition often occurs after an injury and usually affects only one limb. Experts believe CRPS is caused by damage to the peripheral and central nervous systems. It can also be caused by a malfunction of these systems. Symptoms of CRPS include persistent and extreme pain as well as swelling in the affected area and changes in skin color and temperature. While some cases of CRPS are mild, others are very severe and can lead to long-term disability. Several different treatment options exist for those with CRPS, including physical therapy, medication, and surgery.
Background
Although medical experts are not entirely certain what causes CRPS, more than 90 percent of cases involve a history of trauma or injury. Individuals with inflammatory or autoimmune disease are more likely to experience CRPS. The condition is thought to be caused by damage to or an abnormality within the central nervous system or the peripheral nervous system. Common triggers include fractures, sprains, strains, burns, cuts, bruises, limb immobilization, surgery, and minor medical measures such as getting stuck with a needle.
CRPS is divided into type 1 and type 2. Each type has similar symptoms but different causes. Type 1 is also referred to as reflex sympathetic dystrophy (RSD). This type is characterized by no direct damage to nerves. It normally occurs after an injury or an illness. Type 1 accounts for nearly 90 percent of CRPS cases. Type 2, formally known as causalgia, exhibits the same symptoms as type 1 but is the result of a specific nerve injury.
It is unclear why CRPS develops in some people and not others. Not every person who sustains an injury or experiences any kind of physical trauma develops CRPS. Some cases of CRPS develop without a known injury. In such cases, infection, nerve entrapment, or blood vessel problems may explain the development of CRPS. Peripheral nerve abnormalities involving sensory nerve fibers in the body have been discovered in people with CRPS. These fibers carry pain signals to the blood vessels and are involved in the process of inflammation. If a fiber sustains damage, the result can include damage to the brain and spinal cord. Such damage can trigger symptoms of CRPS.
High levels of inflammatory chemicals called cytokines have been observed in the tissues of individuals with CRPS. The increased presence of cytokines can contribute to the symptoms of CRPS, such as redness and swelling. Some experts believe a person’s mental health must be taken into account in some cases, as stress, anxiety, and depression have been known to exacerbate the symptoms of CRPS. Limited data suggests a genetic component.
Overview
The main symptom of CRPS is prolonged, potentially constant pain that ranges in severity. Some patients have described the pain as a burning sensation; others have likened the pain to feeling pins and needles. Some say they simply feel a painful pressure in the affected area. The pain normally stays in one limb, and it can either impact a small site on the limb or affect the entire limb. In some cases, CRPS can affect the whole limb even if the triggering injury only affected a small part of that limb. In some rare cases, the pain will migrate to the opposite limb.
The affected area often experiences increased sensitivity, and the area can be painful even to the lightest touch. Individuals with CRPS also experience changes in skin temperature and color. Skin temperature can either increase or decrease in the affected area depending on the damage. The color of the skin can become blue, purple, red, pale, or blotchy. The affected limb may also become swollen. These symptoms are caused by circulation issues resulting from damage to nerves that control temperature and blood flow. Alongside these symptoms, other common symptoms that occur in the affected area include a change in skin texture, joint stiffness, muscle spasms, decreased mobility, and tremors.
Diagnosis of CRPS is based on the presence of symptoms and a person’s medical history. No specific tests for CRPS exist, and similar symptoms are present in many other conditions. This can make accurate diagnosis difficult. Laboratory blood tests can be utilized to rule out other conditions, such as Lyme disease and arthritis. Magnetic resonance imaging (MRI) or triple-phase bone scans can also help confirm a diagnosis. The bones of individuals with CRPS often undergo a process in which cells break down the bone, which then releases calcium into the blood. This process is not unique to CRPS, however.
CRPS is usually treated with a combination of therapies. Individuals are often referred to a rehabilitation or physical therapy center where they can undertake an exercise program designed to maintain blood flow and circulation in the affected limb. Exercise can also strengthen the limb and improve its function and flexibility. If necessary, occupational therapy is an option to help a person learn new ways to carry out daily tasks. Physical and occupational therapy can be combined with medications to control symptoms of CRPS. Medications that may be effective include analgesics, anesthetics, steroids, antidepressants, and anticonvulsants.
Minor surgical procedures that block nerve pain or destroy affected nerves can also relieve symptoms of CRPS. Neural or spinal cord stimulation is also an option. This type of treatment involves implanting electrodes into the affected areas. These electrodes are then electrically stimulated to provide a tingling sensation in the pain region that relieves discomfort.
CRPS is often associated with mental health issues. Many people with CRPS develop depression, anxiety, post-traumatic stress disorder, or other mental condition. Psychological symptoms can amplify a person’s pain sensitivity, and this can make rehabilitation difficult. Treatment of secondary psychological conditions is an important part of overall treatment for CRPS.
Bibliography
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“Complex Regional Pain Syndrome.” WebMD, www.webmd.com/pain-management/guide/complex-regional-pain-syndrome#1. Accessed 17 Sept. 2018.
“Complex Regional Pain Syndrome – CRPS.” American Society for Surgery of the Hand, www.assh.org/handcare/hand-arm-conditions/Complex-Regional-Pain-Syndrome-CRPS. Accessed 17 Sept. 2018.
“Complex Regional Pain Syndrome Fact Sheet.” National Institute of Neurological Disorders and Stroke, www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Complex-Regional-Pain-Syndrome-Fact-Sheet. Accessed 17 Sept. 2018.
“CRPS Overview / Description.” American RSDHope, www.rsdhope.org/what-is-crps1.html. Accessed 17 Sept. 2018.
“Overview: Complex Regional Pain Syndrome.” National Health Service, www.nhs.uk/Conditions/Complex-Regional-Pain-Syndrome/Pages/Introduction.aspx. Accessed 17 Sept. 2018.
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