Known by many names — Reflex Sympathetic Dystrophy (RSD), Sudeck’s atrophy, causalgia, shoulder-hand syndrome, algodystrophy and transient osteoporosis — Complex Regional Pain Syndrome (CRPS) is a painful and long-lasting condition. CRPS results in severe, constant, burning pain in the affected limb.

The true cause of CRPS is unknown. Experts believe that nerves become very sensitive. Painful stimuli becomes exponentially more painful. And normally non-painful stimuli, such as temperature and even the slightest touch, become very sensitive and extremely painful..

Often, the injury that triggers CRPS is mild compared with the pain that follows it. This very minor injury, appears to affect the nerve fibers. However, the condition can also follow a more severe injury or paralysis. Although sometimes the pain is not limited to the area that was injured. Examples of injuries that can induce CRPS include trauma, fracture, infection, surgery, stroke or even wearing a plaster cast.

The condition can occur at any age, but it is relatively rare in older population.

There are two types of CRPS:

• Type I – there is no nerve damage present

• Type II – a nerve abnormality can be detected

Symptoms

Symptoms of CRPS can include:

• Intense pain, throbbing, burning and swelling, usually in a limb, hand or foot

• Shiny, thin skin around the affected area

• Initially increased but later diminished hair over the affected area

• Brittle, thickened nails

• Dry and withered skin

• Skin that feels warmer or cooler than usual

• Skin that changes color

• Increased sweating

There are 3 stages to disease; however not everyone goes through every stage.

Stage 1:

Days to weeks after the injury the limb can become dry, hot, painful and red. Light touch to the area will cause excruciating pain ,any movement will increase the pain to the extreme. Unfortunately, at this point, CRPS may be mistaken for other diseases or reactions and a physician may not be able to confirm the diagnosis.

Stage 2:

Over the next weeks to months, the skin can become shiny, thin and cool. The limb becomes mottled and purplish. There is considerable swelling. Pain grows even worse. The nails on the affected limb become brittle and can grow faster or slower than normal. And as the limb becomes difficult to move, due to the pain and swelling, the pain may travel further on the affected limb. This can be related to muscle stiffness and soreness, or it can be the CRPS itself.

Stage 3:

Some CRPS patients experience other movement problems, including weakness, spasms and tremors, ranging from mild to severe. The affected limb can also become permanently flexed or bent (contractures). In some patients, the skin can become tight, dry and shriveled. The bones in the limb can become brittle, because they are no longer being used. The skin, muscles and joints can stiffen, resulting in the affected area unable to be moved. Once the disease reaches stage 3, it is extremely difficult to treat.

Getting A Diagnosis

Your doctor will take a comprehensive medical history and do full physical examination. A CRPS diagnosis is dependent upon following :

• Burning, spontaneous and extreme pain

• Hypersensitivity

• Swelling

• Temperature changes

• Sweating

• Skin discoloration

As a physician, in the early stages of CRPS, we need to be very vigilant about pain, especially if the patient’s pain is disproportionate to the injury presented. Early intervention is key, to reduce pain and improve function, to helping control this disease. In later stages, X-rays sometimes show bone loss, especially around the joints. A bone scan can help to confirm that diagnosis. However, the condition of CRPS cannot be diagnosed with a bone scan alone.

Two tests that evaluate nerve function may be ordered. They look for nerve damage, or another cause of the symptoms. The tests are called electromyography and a nerve conduction study.

A doctor may also recommend a diagnostic sympathetic block. This is an injection in the neck or low back meant to determine the reaction of the body and the CRPS pain. This block is intended to improve blood flow and change temperature in the area of the injury. If the block reduces or eliminates pain, this can help to confirm the diagnosis.

Some physicians use other specialized tests to help diagnose the condition. For example:

• Evaluation of the nerves that control sweating and skin temperature. This can be done by measuring sweat output and skin temperature.

  A thermogram maps the temperature in the skin at different sites in the body. This shows how well blood is flowing in different areas. Abnormal blood flow in the painful area is common in CRPS.

Expected Duration

Some people with CRPS improve without treatment. But early treatment by reducing pain and improving mobility does improve the chances of pain relief. If left untreated and the stages of CRPS progress, it becomes very difficult to treat. And about half of people with CRPS continue to experience pain six months after treatment is started. There is no known “cure” for CRPS.

Prevention of CRPS

There is no way to prevent CRPS, as the cause is not clear. But physicians can be aware that certain populations are prone to get the disease.

A hallmark of treatment is early mobility and range of motion, to provide pain relief. This also applies to CRPS that has developed after a stroke.

Therefore, providing physical therapy, as well as continued physical activity, may help prevent CRPS.

Additionally, there is limited evidence that vitamin C (500 milligrams daily) may prevent CRPS following a wrist fracture.

As smoking is a risk factor for CRPS, smoking cessation may play a role in preventing the condition from developing.

If you think you have CRPS, or you have been diagnosed with CRPS, you have treatment options If pain interferes with your life, contact me for an immediate evaluation.