A type of chronic pain that negatively affects an arm or a leg is called complex regional pain syndrome (CRPS). Usually, it appears after an injury, surgery, stroke, or myocardial infarction.
CRPS happens quite rarely, and experts do not fully understand why it happens. The best way to treat this condition is through early diagnosis. When it is found early, the chances of remission increase significantly.
Symptoms
Check below the symptoms that often occur in people with CRPS:
- Persistent burning or throbbing pain (it usually occurs in the arm, leg, hand, or foot)
- Increased sensitivity to cold or touch
- Swelling
- Skin temperature, texture, and color changes
- Hair and nail growth changes
- Joint damage, swelling, and stiffness
- Muscle spasms, tremors, or weakness (atrophy)
- Reduced ability to move specific body parts
The symptoms of CRPS usually change over time. For instance, the first symptoms are swelling, pain, redness, and changes in body temperature. Thereafter, the affected arm or foot can become pale and cold. In most cases, when previous changes occur, the condition becomes irreversible.
Sometimes, CRPS may spread to other limbs. While some people get rid of the symptoms on their own, others may experience the symptoms for years.
You should visit a doctor immediately if the pain caused by the disease lasts and is severe. It is very important to treat this condition early.
Causes
While the condition is not fully understood by experts, they think the condition is caused by an injury to the peripheral nervous system. In most cases, CRPS appears after a trauma or injury. Check below the CRPS types:
- Type 1 – This CRPS type is also called reflex sympathetic dystrophy (RSD), and it usually appears after a disease or injury that does not directly cause damage to the peripheral nerves. Approximately 90% of diagnosed CRPS are the first type.
- Type 2 – This type causes symptoms similar to the first type and is usually referred to as causalgia. It often happens after a nerve injury.
Commonly, people experience CRPS due to a trauma (such as crushing injuries, fractures, and others). However, it may happen due to surgery, myocardial infarctions, infections, and others. Furthermore, not everyone who experiences trauma to an arm or leg develops CRPS. Healthcare providers believe that CRPS occurs due to an interaction between the peripheral and central nervous systems.
What Are The Potential Complications of CRPS?
Without early diagnosis, this condition may cause some complications. Check below some examples:
- Atrophy
- Contracture (muscle tightening)
- Skin and bone changes
- Joint or movement disorders
- Systemic problems
- Mental health issues
- Skin infections
- Open sores
- Palpitations
- Syncope
If the disease is not treated and the condition advances, it may cause serious inflammation and impaired autonomic nervous system. Consult with your doctor about ways to manage complications caused by CRPS.
How to Prevent Complex Regional Pain Syndrome?
Unfortunately, it is not possible to prevent this condition, but you can take steps to reduce the risk. For example:
- Vitamin C – Some studies have shown that people who administer vitamin C supplements after a wrist fracture may reduce the risk of developing CRPS.
- Physical activity after a stroke – As per studies, the risk of CRPS decreases when people get out of bed and walk around after a stroke.
Diagnosis
Healthcare providers usually perform a physical examination and an evaluation of your medical history to diagnose this condition. During physical examination, doctors will check you for irregularities linked with the disease (such as trauma). However, there are no tests that can confirm this condition. Check below some procedures that may indicate CRPS:
- Bone scan – During this test, a radioactive substance is injected into the veins. This allows doctors to see the bones with a special camera. A bone scan can identify bone changes.
- Sweat production tests – There are some tests that measure the amount of sweat on both limbs. Therefore, an uneven amount of sweating may indicate CRPS.
- Imaging tests – These tests are used to get detailed images of multiple body organs and structures. For example, X-rays may show the loss of minerals from the bones. In some cases, imaging tests may also confirm and rule out conditions that cause similar symptoms.
Treatment
Usually, to improve the symptoms caused by CRPS, doctors prescribe a combination of medicines and therapies. Check below some examples:
Medicines
- Pain relievers – There are nonprescription pain relievers that may help lessen pain caused by CRPS. You can use Aspirin, Naproxen sodium, Ibuprofen, Acetaminophen, and others. However, Aspirin should not be taken by children and teenagers because it may cause a life-threatening condition called Reye’s syndrome. If previous medicines do not work, physicians may prescribe stronger painkillers (such as opioids).
- Antidepressants and anticonvulsants – In some cases, antidepressants (such as Amitriptyline) or anticonvulsants (such as Gabapentin) may help treat pain caused by nerve damage (also called neuropathic pain).
- Corticosteroids – This group of medicines is used to decrease inflammation and improve mobility in the affected limbs. Physicians usually prescribe Prednisone.
- Bone-loss medicines – Doctors may recommend Calcitonin or Alendronate to prevent bone loss.
- Sympathetic nerve-blocking medicines – This involves an injection that helps block pain fibers. In some cases, it may help lessen pain caused by CRPS.
- Intravenous Ketamine – Some research showed that low doses of IV (intravenous) Ketamine may help reduce pain.
- Antihypertensives – Some people get pain relief by using blood pressure medicines. Healthcare professionals usually recommend Prazosin, Phenoxybenzamine, and Clonidine.
Therapies
The following treatments are usually prescribed by doctors along with previous medications. For example:
- Heat therapy – Heat may help reduce discomfort caused by swelling and cold skin.
- Topical analgesics – Doctors may recommend some topical treatments to decrease hypersensitivity. They often recommend Capsaicin cream, Lidocaine creams, or patches.
- Physical or occupational therapy – Guided exercises of the affected arms or legs may help reduce pain and improve range of motion and strength.
- Mirror therapy – It involves a mirror to trick the brain. This treatment involves sitting before a mirror and moving the healthy limb. Therefore, it helps the brain perceive it as the limb that is affected by the condition.
- TENS (transcutaneous electrical nerve stimulation) – Some people get pain relief by applying electrical impulses to the affected nerves.
- Spinal cord stimulation – It involves small electrodes that are placed along your spinal cord. Thereafter, they deliver small electrical impulses that may help alleviate pain.
- Intrathecal drug pumps – This therapy involves medicines to reduce pain that are pumped into the spinal fluid.
- Acupuncture – This procedure involves small needles that are inserted into the muscles and connective tissue to stimulate the nerves and increase blood flow.
This condition may return even after successful treatment due to certain triggers such as exposure to cold, intense emotional distress, and others. However, recurrent CRPS can be easily treated with low-dose antidepressants or other drugs.
Frequently Asked Questions
What are the primary symptoms of complex regional pain syndrome?
These include:
- Intense and burning pain that is disproportionate to the trauma
- Increased sensitivity to touch
- Swelling
- Loss of function
- Stiffness
However, there are many health conditions that may cause previous symptoms. That’s why you should visit a doctor if any of the previous symptoms appear, especially after an injury or trauma.
What is the life expectancy with CRPS?
Generally, this condition does not affect life expectancy. However, if the condition worsens and treatments do not work, people may develop a lifelong disability that may cause other health problems (such as weight gain).
What is the best medication for CRPS?
Healthcare providers usually prescribe Gabapentin and Pregabalin for people with CRPS. However, these medications may cause some adverse reactions such as dizziness, sleepiness, weight gain, and others. Discuss with your doctor about the risks and benefits before using these medicines. If you have additional questions, ask your physician.
