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Complex Regional Pain Syndrome – Symptoms and Treatment

Complex Regional Pain Syndrome (CRPS) is a chronic (meaning lasting more than six months) pain condition that usually affects one limb – arm, leg, hand or foot – following an injury or trauma to the affected limb. The most common triggers for CRPS are fractures, muscle sprains or strains, soft tissue injuries (burns, cuts bruises), an immobile limb (cast) or surgical procedures. 

While it’s cause is not completely understood, CRPS is believed to be caused by either damage to or malfunction of the peripheral and central nervous system. The peripheral nervous system involves nerve signaling from the brain and spinal cord to the rest of the body, while the central nervous system consists of the brain and the spinal cord. 

There are two types of CRPS, and while they have similar symptoms and treatments, they have different causes. Type 1, known as reflex sympathetic dystrophy syndrome, occurs after an injury that did not directly affect nerves in the injured limb. This accounts for 90% of cases. Much less common is Type 2, once known as causalgia, which occurs when there is an associated, confirmed nerve injury. 

Symptoms of CRPS 

The primary symptom of CRPS is prolonged, severe pain in one limb that is disproportionate to the original injury. Some patients describe this pain as burning, having a “pins and needles” sensation, or feeling like the affected limb is being squeezed. Additional symptoms include increased sensitivity in the affected area, changes in skin temperature or color, swelling, changes in the texture of the skin, changes in hair and nail growth, joint stiffness, weakened muscles and muscle spasms. 

For some patients, there are three distinct phases. Complex Regional Pain Syndrome stages may include: 

  • Stage 1: which is characterized by the development of pain in a limb either following an event or without any apparent cause. This phase is generally characterized by throbbing pain, a burning sensation, sensitivity to touch or cold, aching and localized edema. 
  • Stage 2: in this stage there is a progression of the soft tissue edema, thickening of the skin, muscle atrophy and the development of brawny skin. This phase may last 3-6 months. 
  • Stage 3: this is the most severe stage and is characterized by limitation of movement, shoulder-hand syndrome, contractures of the digits, skin changes and brittle nails. 

CRPS symptoms vary from patient to patient and often change over time. Nevertheless, in most cases the first symptoms are pain, swelling and redness in the affected limb. 

Complex Regional Pain Syndrome Treatments 

Outcomes of CRPS vary widely and might be associated with the age of the patient, the cause of CRPS and when treatment is received. While it has not been confirmed by research, anecdotal evidence seems to indicate that there are better outcomes when early treatment is received. Most patients have the best result from a combination of treatments that include: 

  • Medications: doctors use various medications to treat CRPS including over-the-counter pain relievers, prescription pain medication, antidepressants and anticonvulsants, corticosteroids, and bone-loss medications
  • Physical Therapy: gentle and targeted exercise of the affected limbs can help to decrease pain and increase range of motion, especially when started soon after the disease is diagnosed
  • Sympathetic nerve blocks: these injections block pain fibers in affected nerves and can provide patients with pain relief
  • Spinal cord stimulation: this is a minimally invasive procedure where tiny electrodes are inserted along the spinal cord; a small electrical current is then delivered to the spinal cord to block pain signals and provide pain relief

Pain from CRPS can be debilitating and can have a significant impact on your quality of life. If you are experiencing pain that makes touching or moving one of your limbs difficult or problematic, contact us today. It’s important to treat CRPS early, so schedule a consultation as soon as possible so that we can provide you with an accurate diagnosis and an effective treatment plan.

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