Complex Regional Pain Syndrome (CRPS) refers to chronic pain in a limb following an injury to it. Arms, hands, legs, and feet are most affected by this disorder, and it is believed to be caused by injury to one of two nervous systems. The systems in question are the peripheral and central nervous systems. The central nervous system directly controls the body’s brain and spine. The peripheral system sends “messages” to the rest of the body from the central nervous system. Both systems can be adversely affected by disease in addition to mechanical injury.
As its name indicates, severe and/or prolonged pain in the affected area is an indicator of complex regional pain syndrome. Swelling in the limb can be another symptom. And CRPS sufferers have reported dramatic color and temperature changes in the affected limb as well.
Officially, CRPS is catergorized into Type I (no confirmed nerve damage) and Type II (confirmed nerve damage). Research has shown however that there are so many similarities between these types that placing them into different categories may not be necessary. The treatment for both types is the same. Physical therapy, psychotherapy, and medications (and often a combination of all three) are treatment options.
Specific CRPS Treatments
Physical therapy for CRPS sufferers focuses on flexibility, strength, and function exercises for the affected limb. Psychological factors do not appear to directly contribute to CRPS. Anxiety and depression over CRPS symptoms can certainly heighten physical ones, however. As a result, counseling and anti-anxiety medication may be part of the overall CRPS treatment plan. Prescribed CRPS medications may include non-steroidal anti-inflammatory medications such as aspirin, ibuprofen, and naproxen.
Such medications are most effective for moderate CRPS discomfort. For inflammation and swelling that often accompanies the early stages of CRPS, corticosteroids such as prednisolone and methylprednisolone can be effective. To treat CRPS neuropathic pain anti-seizure medications such as gabapentin, pregabalin, amitriptyline, nortriptyline, and duloxetine have been used. Botulinum toxin injections, opioids such as oxycontin, morphine, hydrocodone, fentanyl, and vicodin have also been used for pain relief.
And nasal calcitonin has been used for treatment of CRPS deep bone pain. It must be noted that all medications noted here have had widely varying effects on CRPS. CRPS patients contemplating this type of treatment should also consider potential side effects of these medications.
Causes Of CRPS
While CRPS usually comes in the aftermath of a traumatic injury such as a break or a sprain, the level and length of pain is considered excessive. Most trauma sufferers do not experience CRPS after injury. For those that do, the experience is considered comparable to an allergic reaction. Researchers think one cause of this “allergy” is a pre-existing condition in the victim’s peripheral nervous system. Another trigger of CRPS may be blood cells that dilate more fully. Other possible causes are genetics, auto-immune system defects, and pre-existing disease.
Effectiveness Of CRPS Treatment
The younger the patient and the earlier that the treatment begins, the better the outcome. However, although much good individual data has been recovered, a good all-purpose clinical treatment has not yet been developed. Experts agree that more research needs to be done on this syndrome to formulate a truly effective treatment.
Dr. Luis Fandos is a Babylon, NY based certified anesthesiologist.