Complex Regional Pain Syndrome (CRPS/RSD)

Complex Regional Pain Syndrome (CRPS), previously called Reflex Sympathetic Dystrophy (RSD), is a condition that generally affects an arm or a leg but can affect other body parts. CRPS is a neuropathic pain condition – that means it is caused by a malfunction within the nervous system that may develop after surgery, fracture, sprain, or other injury.

CRPS pain typically persists long after the initial injury is healed and becomes associated with discoloration, swelling, and hypersensitivity of the injured body part. The CRPS pain may be severe, and if untreated may lead to atrophy (wasting) of the skin, muscle, and bone leading to long-term disability.

Watch this video to learn more about Complex Regional Pain Syndrome.

Complex Regional Pain Syndrome Symptoms:

CRPS/RSD symptoms can vary in severity and duration. Pain can become continuous, intense, and spread over a period of time.

Signs and symptoms in the affected body part may include:

• Pain described as burning or throbbing.
• Hypersensitivity to cold or touch.
• Swelling and stiffness in the joints.
• Reddish discoloration
• Skin changes such as increased or decreased skin temperature, increased swelling, thin or shiny skin.
• Changes in hair and nail growth pattern
• Decreased motor function and disability.

Complex Regional Pain Syndrome Causes:

• Often occurs after trauma to a limb, such as a sprain, fracture, or crush injury.
• Surgery, or penetrating injury from knife or bullet, may also cause CRPS.
• Emotional stress can aggravate CRPS.

The causes of CRPS (RSD) are not entirely understood but doctors believe it is triggered by an injury that causes the sympathetic nervous system to malfunction leading to inappropriate pain and inflammation. The sympathetic nervous system is normally involved in sweating, blood flow and the ‘fight or flight’ response and does not transmit pain sensation except when injured. An abnormal immune response to the healing process which results in hypersensitivity, swelling, warmth, and redness in the affected area may contribute to CRPS.

There are two types of CRPS with similar signs and symptoms, but different origins.

• CRPS Type 1 occurs after an injury without any identifiable direct damage to nerves in the affected body part. It is believed that pain receptors in CRPS Type 1 patients become sensitive to catecholamines, chemicals that work as messengers in the nervous system and are associated with the sympathetic limb of the nervous system.
• CRPS Type 2 is associated with a distinct and identifiable nerve injury after surgery or penetrating trauma. The majority of patients with CRPS, estimated to be around 90%, have CRPS Type 1.

Complex Regional Pain Syndrome Diagnosis and Treatments:

No single test can diagnose CRPS/RSD. A physical exam and a medical history will be the first step of diagnosis, followed by procedures that may provide insight. Some of the procedures that may be helpful include a sympathetic nervous system nerve block, bone scan, x-rays, and MRI.

As with many conditions, if CRPS is treated in the early stages it can be reversed much more effectively than if left for long periods of time untreated.

Various medications can be used for CRPS pain relief, including pain medications, corticosteroids, bone-loss medication, and stabilizing drugs. Hot and cold applications to the site and topical analgesics can be performed at home, and physical therapy is very important to maintain limb mobility and restoration of function

Spinal cord stimulation, dorsal root ganglion stimulation, and targeted drug delivery via pain pump are used for severe CRPS that does not improve with more conservative therapies.

CRPS Treatment options include:

• Lumbar Sympathetic Nerve Block
• Stellate Ganglion Nerve Block
• Spinal Cord Stimulation (SCS)
• Dorsal Root Ganglion (DRG) Stimulation
• Targeted Drug Delivery via Spinal Pain Pump
• Physical Therapy

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