Complex Regional Pain Syndrome

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What is it?

Complex regional pain syndrome (CRPS) is a disorder of a body region, usually of the extremities that is characterized by pain, swelling, limited range of motion, skin changes and patchy bone demineralization. It frequently results after an injury, surgery or other significant event such as a stroke.
There are many alternative names for CRPS including reflex sympathetic dystrophy, algodystrophy, causalgia, Sudeck’s atrophy, transient osteoporosis and acute atrophy of the bone. Upper extremity involvement following a stroke or myocardial infarction (heart attack) is sometimes referred to as the “shoulder-hand syndrome.” A diagnosis of CRPS requires the presence of regional pain and sensory changes following a medical event. The pain is of a severity greater than that expected from the inciting injury and is often associated with such findings as abnormal skin colour, temperature change, abnormal sudomotor activity (sweating), or edema (fluid imbalance in the body).

How did I get it?

The cause of CRPS is unclear, but appears to involve an abnormal reaction of the nervous system to an inciting event. The abnormal response magnifies the pain, increases sensitivity to other stimuli and causes vascular disturbances (swelling and skin changes). 40% of the time CRPS is a result of a soft tissue injury such as a torn rotator cuff, broken arm bone, ankle sprain or knee injury.

What are the symptoms?

CRPS commonly occurs in either the upper or the lower extremities. Involvement of both upper and lower limbs in the same patient is unusual but possible as manifestations of CRPS can spread from the site of injury to a different location. Three stages may occur during the course of CRPS.

Stage 1 — Either after an event or without apparent cause, pain develops. The essential features include burning throbbing pain, diffuse uncomfortable aching, sensitivity to touch or cold and localized swelling. There is poor control of blood vessels which may result in altered colour and temperature. X-rays are usually normal at this time.

Stage 2 —Marked by progression of the soft tissue swelling, thickening of the skin and other soft tissues. The muscle may waste away during this stage. This may last for three to six months.

Stage 3 —Is the most severe. It is characterized by limitation of movement and sometimes contractures, further skin and nail changes. X-rays will show demineralisation in this stage. The longer the CRPS is in stage 3 the more difficult it is to treat.

What should I do?

Early diagnosis and intervention is paramount. It is important to get a correct diagnosis and early appropriate management. If you have symptoms of worsening and disproportionately severe pain, skin colour changes and swelling you would be encouraged to see a medical professional. This is not a condition that responds well to rest.

How is a diagnosis made?

A diagnosis is made on the nature of the pain symptoms. Often scans, blood tests and nerve studies will be ordered to help confirm the diagnosis and eliminate other possible causes.

What does rehab involve?

A multidisciplinary approach is considered best practice. You will need to see a pain specialist, physiotherapist, occupational therapist and psychologist for ongoing education and therapy. Some medications can also be useful.

 

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