Complex Regional Pain Syndrome (CRPS)

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Reflex Sympathy disorder is estimated to
to afflict between 1.5 and 6
Million people in the US

CRPS is estimated to afflict between 1.5 and 6 million people in the U.S. – that’s more than breast cancer, HIV/AIDS, and multiple sclerosis combined. It is believed to be caused by an overactive nervous system. Also known as Reflex Sympathy Distrophy (RSD), the disease is not clearly understood. It is characterized by intense, continuous burning pain most often affecting the arms, legs, hands, or feet.
There are three progressive stages of CRPS, and the disorder can spread in some cases up the spine from a leg to an arm, and from an arm up into the head. Initially, symptoms may include swelling and sweating, along with temperature and color changes in the affected area. Severe atrophy, disfiguring muscle contractions and osteoporosis may follow.

CRPS is most common in people between the ages of 40 and 60, but it can occur at any age. Studies indicate that women are more likely to be affected by CRPS than men.

CRPS: Symptoms

The key symptom of complex regional pain syndrome is continuous burning pain. Other symptoms include:

  • Swelling and joint tenderness
  • Loss or diminished motor function
  • Changes in skin temperature and color
  • Bone softening – patchy osteoporosis
  • Muscle spasms and tremors
  • Increased sweating at affected area

A CRPS sufferer may exhibit one, several, or all of these symptoms.

CRPS: Diagnosis

Diagnosing CRPS can be very difficult. Unfortunately, there is no single laboratory test to diagnose the disorder. Your doctor will conduct a thorough medical history and physical examination. You can help by providing a list of any treatments you have received and your response to them, as well as a summary of any hospitalizations and surgeries.

Your doctor will first need to rule out other potentially life-threatening disorders that may have similar clinical features. For example, a blood clot in a leg vein or a breast tumor spreading to lymph glands can cause a swollen, painful extremity. In fact, CRPS may be associated with another disease or disorder, (e.g., a herniated disc of the spine, carpal tunnel syndrome, or heart attack).

There are several diagnostic tests that may help diagnose CRPS or rule out other disorders. A thermogram is probably one of the most widely used tests. It measures heat emission from the body surface using a special infrared video camera.

Your neurologist may request additional testing including X-rays, EMG, Nerve Conduction Studies, CAT scan, and Magnetic Resonance Imaging (MRI) studies to help exclude or identify other possible causes of pain.

CRPS: Treatment

The many forms of treatment for CRPS include medication, sympathetic nerve blocks, physical therapy, psychological support, and spinal cord stimulation. Your patient care team will develop a treatment plan that makes sense for you. Because there is no cure for CRPS, treatment is focused on relieving pain.

Medications that may be prescribed to treat CRPS include:

  • Analgesics (e.g., Vicodin, morphine, fentanyl)
  • Relaxants (e.g., Soma, Baclofen)
  • Antidepressants (e.g., Elavil, Trazodone)
  • Hypnotics (e.g., chloral hydrate)
  • NSAIDS (e.g., Motrin, Voltaren, etc.)
  • Steroids (e.g., Medrol dose pack)
  • Adrenergic alpha-1 and alpha-2 blocking drugs (e.g., phentolamine, yohimbine )
  • Calcium channel blockers (e.g., Procardia)
  • Oral local anesthetics (e.g., Mexiletene)
  • Anticonvulsants (e.g., Tegretol, Neurontin)

Other treatments may include:

Physical therapy: Physical therapy typically focuses on performing a daily range of motion exercises. Mobilization of the affected limb is a very important part of treatment but should be performed ONLY by a therapist who is familiar with CRPS. CRPS patients are particularly susceptible to osteoporosis and joint injury. The goal of physical therapy is to keep the limb moving as much as possible to enable the patient to perform normal activities. Aquatic therapy at a comfortable water temperature can often facilitate mobilization of extremities, especially if CRPS is in a lower extremity.

Sympathetic nerve block: A sympathetic nerve block is a specialized test used both to diagnose and to treat pain. Sympathetic nerves control sweating, heart rate, blood vessels, pupil dilatation, movement of food through the intestines, and many other body functions. This network of nerves extends the length of the spine.

Spinal cord stimulation: This procedure uses an electrical current to treat chronic pain. A small pulse generator, implanted in the back, transmits electrical pulses to the spinal cord. These pulses interfere with the nerve impulses responsible for chronic low back pain or leg pain and numbness.

Intrathecal drug delivery: Pain medication is delivered through a catheter directly to the spinal cord. This pain management option, also known as a “pain pump,” may be used if all other traditional methods have failed to relieve your long-term symptoms. The system uses a small pump that is surgically placed under the skin of your abdomen and delivers local anesthetic agents and opiods (morphine or baclofen) to the area around your spinal cord.

CRPS: Resources

American Chronic Pain Association (ACPA)
P.O. Box 850
Rocklin, CA  95677-0850
Tel: 800-533-3231
Fax: 916-632-3208

American Pain Foundation
201 North Charles Street
Suite 710
Baltimore, MD 21201-4111
Tel: 888-615-PAIN (888-615-7246)
Fax: 410-385-1832

American RSDHope
P.O. Box 875
Harrison, ME  04040-0875
Tel: 207-583-4589

International Research Foundation for RSD/CRPS
1910 East Busch Boulevard
Tampa, FL 33612
Tel: 813-907-2312
Fax: 813-830-7446

Mayday Fund (for pain research)
c/o SPG
127 West 26th Street, Suite #800
New York, NY 10011

American Chronic Pain Association
P.O. Box 850
Rocklin, California, 95677
United States
Tel: 800-533-3231 or 916-632-0922
Fax: 916-632-3208

National Headache Foundation
820 N. Orleans
Suite 217
Chicago, IL 60610-3132
Tel: 773-388-6399  or 888-NHF-5552 (888-643-5552)
Fax: 773-525-7357

Reflex Sympathetic Dystrophy Syndrome Association (RSDSA)
P.O. Box 502
Milford, CT 06460
Tel: 203-877-3790  or 877-662-7737
Fax: 203-882-8362

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