Complex regional pain syndrome (CRPS) is a chronic pain condition.
Complex regional pain syndrome (CRPS) is a chronic pain condition. It causes intense pain, usually in the arms, hands, legs, or feet. It may happen after an injury, either to a nerve or to tissue in the affected area. Rest and time may only make it worse.
Symptoms in the affected area are
- Dramatic changes in skin temperature, color, or texture
- Intense burning pain
- Extreme skin sensitivity
- Swelling and stiffness in affected joints
- Decreased ability to move the affected body part
The cause of CRPS is unknown. There is no specific diagnostic test. Your doctor will diagnose CRPS based on your signs and symptoms.
There is no cure. It can get worse over time, and may spread to other parts of the body. Occasionally it goes away, either temporarily or for good. Treatment focuses on relieving the pain, and can include medicines, physical therapy, and nerve blocks.
There is no known prevention at this time. Early treatment is the key to slowing the progression of the disease.
Doctors are not sure what causes CRPS. In some cases, the sympathetic nervous system plays an important role in the pain. Another theory is that CRPS is caused by a triggering of the immune response, which leads to the inflammatory symptoms of redness, warmth, and swelling in the affected area.
CRPS has 2 forms:
- CRPS 1 is a chronic nerve disorder that occurs most often in the arms or legs after a minor injury.
- CRPS 2 is caused by an injury to the nerve.
CRPS is thought to result from damage to the nervous system. This includes the nerves that control the blood vessels and sweat glands.
The damaged nerves are no longer able to properly control blood flow, feeling (sensation), and temperature to the affected area. This leads to problems in the:
- Blood vessels
Possible causes of CRPS:
- Injury directly to a nerve
- Injury or infection in an arm or leg
In rare cases, sudden illnesses such as a heart attack or stroke can cause CRPS. The condition can sometimes appear without obvious injury to the affected limb.
This condition is more common in people ages 40 to 60, but younger people can get it, too.
The key symptom is pain that:
- Is intense and burning, and is much stronger than would be expected for the type of injury that occurred.
- Gets worse, rather than better over time.
- Begins at the point of injury, but may spread to the whole limb, or to the arm or leg on the opposite side of the body.
In most cases, CRPS has 3 stages. But, CRPS does not always follow this pattern. Some people develop severe symptoms right away. Others stay in the first stage.
Stage 1 (lasts 1 to 3 months):
- Changes in skin temperature, switching between warm or cold
- Faster growth of nails and hair
- Muscle spasms and joint pain
- Severe burning, aching pain that worsens with the slightest touch or breeze
- Skin that slowly becomes blotchy, purple, pale, or red; thin and shiny; swollen; more sweaty
Stage 2 (lasts 3 to 6 months):
- Continued changes in the skin
- Nails that are cracked and break more easily
- Pain that is becoming worse
- Slower hair growth
- Stiff joints and weak muscles
Stage 3 (irreversible changes can be seen)
- Limited movement in limb because of tightened muscles and tendons (contracture)
- Muscle wasting
- Pain in the entire limb
If pain and other symptoms are severe or long-lasting, many people may experience depression or anxiety.
Diagnosing CRPS can be difficult, but early diagnosis is very important.
The doctor will take a medical history and do a physical examination. Other tests may include:
- A test to show temperature changes and lack of blood supply in the affected limb (thermography)
- Bone scans
- Nerve conduction studies
There is no cure for CRPS, but the disease can be slowed. The main focus is on relieving the symptoms and helping people with this syndrome live as normal a life as possible.
Physical and occupational therapy should be started as early as possible. Starting an exercise program and learning to keep joints and muscles moving may prevent the disease from getting worse. It can also help you do everyday activities.
Medicines may be used, including pain medicines, corticosteroids, certain blood pressure medicines, bone loss drugs and antidepressants.
Some type of talk therapy, such as cognitive behavioral therapy or psychotherapy, can help teach the skills needed to live with chronic pain.
Surgical or invasive techniques that may be tried:
- Injected medicine that numbs the affected nerves or pain fibers around the spinal column (nerve block)
- Internal pain pump that directly delivers medicines to the spinal cord (intrathecal drug pump)
- Spinal cord stimulator, which involves placing electrodes (electrical leads) next to the spinal cord. A low-level electrical current is used to create a pleasant or tingling sensation in the painful area is the best way to reduce pain in some people.
- Surgery that cuts the nerves to destroy the pain (surgical sympathectomy), although it is unclear how many people this helps. It may also make some person's symptoms worse.