Complex Regional Pain Syndrome (CRPS)
Complex regional pain syndrome (CRPS) is a chronic pain and sensory condition that usually affects the limbs of the body. It has been known as reflex sympathetic dystrophy (RSD), causalgia, Although it affects women more often, men can also be diagnosed with CRPS. It is most common in those between the ages of 40-60.
Diagnosis of CRPS has been troublesome over the years because of the number of potential symptoms associated.Since 2003 there is a new diagnostic criteria that have become more widely accepted. These are known as the “Budapest diagnostic criteria for CRPS”. The Budapest criteria have four categories and a patient must have at least one symptom in all four categories to be diagnosed with CRPS. The categories are:
1- Continuous pain, which is disproportionate to any inciting event.
2- Must report at least one symptom in 3 of the 4 following categories:
– Sensory: Reports of hyperesthesia and/or Allodynia
– Vasomotor: Reports of temperature asymmetry and/or skin color changes and/or skin color asymmetry.
– Sudomotor/Edema: Reports of edema and/or sweating changes and/or sweating asymmetry.
– Motor/Trophic: Reports of decreased range of motion and/or motor dysfunction (weakness, tremor, dystonia) and/or trophic changes (hair, nail, skin)
3- Must display at least one sign at time of evaluation in two or more of the following categories:
– Sensory: Evidence of Hyperalgesia (to pinprick) and/or Allodynia (to light touch and/or deep somatic pressure and/or joint movement).
-Vasomotor: Evidence of temperature asymmetry and/or skin color changes and/or asymmetry.
– Sudomotor/Edema: Evidence of edema and/or sweating changes and/or sweating asymmetry.
-Motor/Tropic: Evidence of decreased range of motion and/or motor dysfunction (weakness, tremor, dystonia) and/or trophic changes (hair, nail, skin)
4- There is no other diagnosis that better explains the signs and symptoms.
Allodynia is when pain is produced by a stimulus that would otherwise be a non-painful sensation (brushing by someone, for example). Hyperalgesia is when a normally painful stimulus becomes much more painful than would normally occur. These are thought to involve both the central nervous system (CNS) and the peripheral nervous system (PNS). There are two types of complex regional pain syndrome that affect different people. The first and more common type, is type I and involves persistent pain and swelling in areas that have sustained trauma and produces vasomotor disorders. Type II is a result of a specific nerve injury.
Complex regional pain syndrome is a relatively rare disease that can greatly affect a person’s lifestyle. Those who suspect that they may be suffering from CRPS should be evaluated as soon as possible. There are a number of options that the doctor will discuss with a patient if CRPS is diagnosed. Some possible options a doctor might consider are:
Spinal Cord Stimulation– Tiny electrodes are placed in the epidural space next to the spine. It delivers small amounts of electrical current to the nerves, causing a block of pain signals to the brain.
Ketamine Infusion Therapy– Because the pain caused by CRPS tends to be resistant to narcotic/opioid medication, a ketamine infusion is often a great solution. It works by causing a disassociation between the thalamus and the limbic systems, putting the patient in what is often described as a “dreamlike” state. The doctor will likely administer a low dose of Midazolam (Versed) in order to reduce the likelihood of hallucinations in patients.
Sympathetic Nerve Blocks– Sympathetic nerve blocks involve medication being injected to the origin of the sympathetic nerves. When CRPS is affecting the head or upper extremities, a stellate ganglion block or brachial plexus nerve block will be preformed. If the lower extremities are affected, a lumbar sympathetic nerve block is preformed.
Peripheral Nerve Stimulation– Much like the spinal cord stimulation, the peripheral nerve stimulation involves electrodes being placed next to the affected nerves and interrupting their signals with a minor electrical current.
Physical Therapy– Physical therapy is most often used in conjunction with other treatment options. Physical therapy will help a patient maintain or increase range of motion by exercising affected limbs.
Medical management- a number of medications can be helpful in controlling pain and symptoms involved with CRPS. These include NSAIDs, membrane stabilizing drugs, and opioid medications.
Biofeedback– During this treatment, a patient will learn to become more aware of their body and its functions. When a patient can control otherwise involuntary actions, pain relief is often achieved.