All About Complex Regional Pain Syndrome (CRPS)

By Adam Spjute, MD

What is Complex Regional Pain Syndrome?

Complex regional pain syndrome is a syndrome that’s caused from nerves that continue to fire, particularly in extremities (which means the furthest point in a limb) that causes swelling, discoloration and decreased movement when there’s no obvious pathology.

There are several components that are necessary for it to fall under Complex Regional Pain Syndrome. You need pain, discoloration, swelling, and generally there’s decreased mobility.

How Long Has Complex Regional Pain Syndrome Been Around?

The first recorded instance of Complex Regional Pain Syndrome was in the Civil War. There were a lot of scholarly papers and articles that spoke about finding soldiers in battle who had had gunshot wounds to their arms or their legs that developed this unique pain disorder in those limbs.

They had a different name at the time, and though they didn’t have a full understanding of what it was, they knew that these men who fought in battles would have pain even after their wounds were healed. 

Sure, it’s been around since man has been on earth, but the patterns that went on in the Civil War were hard to ignore. These men and women would have a gunshot wound or an injury by blunt force, there was no bruise or cut, but yet their hands would turn red, they wouldn’t be able to move their extremities and they’d feel burning if any part of the hurt area was touched.

Though gunshot wounds aren’t as common in daily life, people certainly deal with Complex Regional Pain Syndrome today. Thankfully, we have more of an understanding of it!

Any type of blunt trauma can cause Complex Regional Pain Syndrome. Lifting and dropping a piece of  heavy  machinery on your foot, smashing a hand when putting away a large box, or dropping a pallet on your foot. These are just a few of many things that could happen to cause Complex Regional Pain Syndrome (CRPS).

What Causes Complex Regional Pain Syndrome?

Though we’re still not quite sure what causes it, what we think is happening is that different nerve cells are stuck sending signals to the body that it’s in pain. Because there was a previous injury to the body, these nerve cells think that there’s still pain, so it keeps sending signals to the brain that it needs help. Our solution? To “reset” it. Imagine a CD that keeps skipping over and over again. Over time, the more that CD skips, the less likely you’ll be able to fix it. 

A lot of times, we see patients who’ve had ankle or wrist surgeries who experience this. Others have smashed their hands in the car door, got an x-ray, they see that nothing’s broken, but weeks later get this severe pain that’s almost impossible to ignore. 

Related: The APC Difference: Our Multidisciplinary Approach to Patient Care

How Easy is Complex Regional Pain Syndrome to Diagnose?

Typically, it presents itself as very extreme pain. Even lightly touching the skin over it will make it hurt severely. Another common symptom is the discoloration seen on top of the severe pain, and then there’s also the inability to move it.

Now, how much could this really hurt? Well, we’ve seen people who have to wrap up their arm or leg when they’re getting dressed because they’re feeling such severe pain. Imagine that!

Diagnosing it isn’t too difficult on our end, especially now that we’ve had research around CRPS way after the Civil War, when doctors had no idea why an extremity was hurting so much even without any visual cues of injury.

What’s important is getting treatment early. Typically, we see patients who want to get help pretty soon, especially if their pain is as unmanageable as other severe cases. But if people wait, and the diagnosis happens after several years of a patient experiencing this pain, treatments can be more difficult, but are still effective.

How Does APC Address Complex Regional Pain Syndrome?

Physical therapy is usually our first-line treatment with pain management, because we want to ensure we’re being as minimally invasive as possible here at APC. The problem is that for patients with Complex Regional Pain Syndrome, their pain is far too severe to actually have successful physical therapy treatments without being in hard-to-manage pain.

What we’ll typically do is special nerve block injections to actually block the nerves so the pain can go away. Once that’s been completed successfully, then they’ll be able to participate in physical therapy to partake in different desensitization techniques.

Sometimes though, thouse injections just aren’t enough, and the pain is still severe.  They could start responding to it a little bit, and then the pain will come back in full force again. 

Something that we’ve found a lot of success with is spinal cord stimulation, especially with our Complex Regional Pain Syndrome patients. Similar to how it acts on the spinal  cord to block the different pain signals, another thing it does is increases blood flow. With increased blood flow comes increased oxygen, with increased oxygen comes increased tissue healing.

The spinal cord stimulation is great for a minimally-invasive but highly-effective solution to those who are in pain. They’re much less invasive than a back, hand or foot surgery, and here at APC, we try our best to avoid invasive surgery that’s not absolutely needed.

There are medications as well, but they’re typically not very helpful and have a lot of side effects like sleepiness and constipation. With the state of our current opiate epidemic, it’s not really something that helps with CRPS in the long run.

So we’ll try physical therapy and injections first, then if it’s not effective, we can treat our patients with the spinal cord stimulator. This is a 2 part procedure in which the first part is a 1 week temporary trial. Patients get to experience spinal cord stimulation in either the neck or the back to help with their pain. At the end of the trial, we meet with the patient and discuss moving on to the second part if it’s the right choice for them. 

The second part is the permanent implant, which is a minimally invasive surgery where the spinal cord stimulator is implanted.  Most of the time we use the same type of electrodes as before, but now the battery will go under the skin (it’s only about the size of a double-stuffed Oreo!).

Related: The Need for Spinal Cord Stimulation

Now, the Spinal Cord Stimulator isn’t just limited to patients with CRPS; but it’s certainly a great choice for those who are experiencing too much pain for physical therapy alone.

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If you’re suffering from pain after the fact, especially without any signs of bruising or broken bones, you might have Complex Regional Pain Syndrome. Remember that it’s always better to seek help early in the process rather than later, and that here at Advanced Pain Care, we know that although pain is inevitable, suffering is optional.