Overview:
Complex Regional Pain Syndrome Treatment Clinic, Austin
CPRC manifests as a chronic pain condition that often occurs after trauma or surgery in the extremities of the body – usually the limbs.
Complex Regional Pain Syndrome, or CRPS, is known to affect approximately 26 people out of a 100,000 around the world. The pain caused form this syndrome is predominantly due to damage, abnormal swelling, or dysfunction of the nerves in the region. This condition often shows up predominantly more in women than men, and usually (although not always) starts to affect people in their mid-30s.
What are the causes of Complex Regional Pain Syndrome or CRPS?
It is estimated that approx. 2–5% of patients with peripheral nerve injury and 13–70% of patients with paralysis of one side of the body will develop CRPS. It is also estimated that about 7% of patients who have had CRPS manifested in one limb will develop it in the other as well.
Complex Regional Pain Syndrome usually starts as extreme pain in one limb, evolves to the skin and bones and leads to a decreased range of motion. It can, in some cases, start spreading to the rest of the body.
About 10% of patients report no specific cause for the manifestation of Complex Regional Pain Syndrome (indicating the possibility of an internal nerve injury), although CRPS usually develops after (or due to) any of the following health conditions:
- Autoimmune and inflammatory disorders
- Forceful bodily trauma
- Limb immobilization
- Sprains/Strains
- Nerve lesions
- Cuts or burns
- Heart attack
- Contusions
- Infections
- Fractures
Although a person might experience one or more of these health conditions does not necessarily mean they will develop CRPS. Why certain patients develop CRPS and others do not are still questions the medical community is trying to answer.
What is known about CRPS is that it is a neurological condition predominantly caused by damage to the peripheral sensory neurons. The improper functioning of the peripheral c-fiber nerves impacts the ability of the brain and the spinal cord to send the appropriate pain signals to the rest of the body. Another characteristic of CRPS is the inflammation caused by the excessive firing of the neurons.
What are the types of Complex Regional Pain Syndrome or CRPS?
Complex Regional Pain Syndrome is a very broad-based term that is used to denote a neurological condition. CRPS is typically characterized by extreme pain and inflammation in the arm(s) or leg(s) and can cause chronic pain.
There are two basic types of classifications for this condition, and this differentiation is made based on one main factor – if there is evidence of nerve damage present in the region that is affected.
Type 1 — This type of Complex Regional Pain Syndrome is also known as Sudeck’s atrophy or Reflex Sympathetic Dystrophy (RSD). This type is characterized by the lack of evidence of nerve damage in the affected limb, and accounts for approximately 90% of all known cases.
Type 2 — Causalgia, or type 2 Complex Regional Pain Syndrome, is characterized by evidence of nerve damage in the affected region.
What are the signs and symptoms of Complex Regional Pain Syndrome or CRPS?
In the past, patients were classified with Type 1 CRPS whenever there was a lack of evidence of nerve damage. In these cases, without obvious signs of nerve damage being present, the symptoms were noticed to be more subtle than in CRPS type 2.
The symptoms for both Type 1 CRPS and Type 2 CRPS both come across as identical, with stronger symptoms manifested in Type 2.
Signs and symptoms include:
- Hypersensitivity to cold and to touch (allodynia or hyperalgesia)
- Constant or fluctuating pain that can often be unprovoked
- Constant sense of burning in the affected regions
- Swelling in the affected regions
- Decreased range of motion
- Stiffness in joints
- Changes in skin color – from white to red or blue
- Fluctuations in temperature of the affected part
- Impaired muscle strength
- Changes in hair or nails
- Changes in skin texture
- Wasting away of bone
Those diagnosed with Type 2 CRPS also have more extensive symptoms, which can include:
- Loss of control over motor activities
- Muscle weakness and shrinkage
- Tremors or sudden jerking of the body
- Dystonia or abnormal fixed postures
In more severe cases, the symptoms can include the inability to use limbs, regression of normal bodily functions such as hair growth, etc.
Since CRPS is considered a systemic issue, it can also affect any organ in the region where it presents itself.
Induced by trauma, injury, or surgery, the main characteristics of this syndrome are – severe pain, as well as an impairment to the sensory, motor, trophic, and autonomic functions of the body.
Impairment | Type 1 CRPS | Type 2 CRPS |
| Sensory |
|
|
| Motor |
|
|
| Trophic |
|
|
| Autonomic |
|
|
Type 1 CRPS Impairment
Sensory
- Allodynia and hyperalgesia
- Hypersensitivity
- Feeling of dislocation in the limbs
Motor
- Muscle weakness
- Stiffness
- Tremors
- Reduced range of motion
- Inability to move the affected region
Trophic
- Osteoporosis
- Fibrosis
- Changes in hair and/or nail growth
- Changes in skin texture
Autonomic
- Swelling
- Edema
- Changes in skin color
- Abnormalities in blood flow
- Changes in temperature and sweating
Type 2 CRPS Impairment
Sensory
- Allodynia and hyperalgesia
- Hypersensitivity
- Intolerance even to mild sensations on the skin
Motor
- Muscle weakness
- Stiffness
- Tremors
- Reduced range of motion
- Inability to move the affected region
- Dystonia
Trophic
- Acute arthritis
- Mottling of skin
Autonomic
- Distal extremity swelling
- Changes in skin color
- Abnormalities in blood flow
- Changes in temperature and sweating
What are the stages of Complex Regional Pain Syndrome or CRPS?
Symptoms vary from case to case and can change over time. In some cases, the symptoms are mild and abate on their own as the injured nerve regrows. In others, they may persist for years.
If the condition progresses without timely medical intervention, it can progress into higher stages of pain (although not always the case with children).
- Stage 1 — Acute — Lasts between 10 days to about 6 months. It is characterized by severe pain, hyperalgesia, allodynia, hypersensitivity, swelling, mild temperature changes, hyperthermia, dryness of skin, and an increase/decrease in hair/nail growth.
- Stage 2 — Dystrophic — Begins at the end of the acute stage and typically lasts for 6 months post that. There is an increase in pain, swelling and other symptoms, along with joint stiffness. Skin can get thin and sweaty, and nails become thin and hard. The onset of osteoporosis and bone erosions are noticed.
- Stage 3 — Atrophic — This can last for years. Pain may be experienced all over the body, with stronger manifestations of other symptoms. The onset of ankylosis and demineralization is noticed. Fingertips and toes get atrophic.
What are the risk factors of Complex Regional Pain Syndrome or CRPS?
Trauma, injuries, surgeries, or infections are the usual causes of Complex Regional Pain Syndrome. However, there is no direct connection between the cause and the severity of the manifestation. There are some risk factors that are known to increase the incidence of Complex Regional Pain Syndrome.
These include:
- Occupations where high-impact trauma can occur
- History of psychological disorders
- Stressful lifestyle
- Neuropathy
- Malignancy
- Post-surgery for Distal Radius Fractures (DRF)
- Rheumatoid arthritis
- High-impact sports
- Smoking
When should I see a doctor?
It is important to treat CRPS as early as possible. Once the symptoms progress, they can become irreversible. Also, if you are experiencing persistent and high-intensity pain and are unable to touch or move the affected limb, contact your physician at Advanced Pain Care immediately to schedule an appointment so they can determine the cause.
How is Complex Regional Pain Syndrome or CRPS diagnosed?
As the symptoms are so varied, diagnosis of CRPS usually depends on the clinical findings including evidence of sensory, vasomotor, sudomotor, and/or trophic changes.
A diagnosis involves a thorough clinical evaluation by a healthcare professional and involves the following evaluations:
- Patient’s medical history including genetic predispositions
- Trauma, surgery, or injury details
- History of sensory, motor, autonomic, trophic disturbances
- Assessment of swelling
- Current signs and symptoms
- Physical examinations
There are no tests that specifically identify the injured nerves. However, there are some basic criteria that are prescribed by the Budapest Criteria to determine the manifestation of CRPS. Clinical diagnostic criteria include the following checklist:
- Distinct signs that symptoms are being developed in at least two other lists of characteristics
- Clear indication that the symptoms displayed are not for any other illness or condition
- Persistent, higher than normal pain
- At least one symptom from the categories of motor, sensory, trophic, and autonomic list of characteristics
Apart from these criteria, a healthcare specialist may prescribe the following tests to determine characteristics and signs:
- Nerve conduction studies to detect nerve injuries
- Magnetic resonance neurography or imaging to check for bone/bone marrow
abnormalities to identify the injured nerves - Triple-phase bone scans to check for excess bone resorption
- Infrared thermography to determine asymmetries in temperature
- Sweat testing
- X-rays to check bone structure irregularities
- Bone densitometry to determine the state of the bone mineral
- Sympathetic blocks
In addition, the specialist will also check basic body functions including movements such as sitting and rising, walking up the stairs, foot movements, grip strength, etc. Additional measures include a neuropathic pain questionnaire, impairment sum score and a CRPS severity score (also used for self-monitoring).
How is Complex Regional Pain Syndrome or CRPS treated?
Treatment of Complex Regional Pain Syndrome can be effective immediately. At the onset, pain, inflammation, temperature changes, and hypersensitivity are common. When symptoms, such as skin and growth changes or muscle spasms, begin to occur then it is a sign that the condition has reached an irreversible stage and can start causing disabilities. In some cases, dystonia or abnormal fixed postures and tremors can also occur. These cases can only be treated by an Orthopedic surgeon.
Treatment of CRPS is usually multi-modal, with the pain care specialists at Advanced Pain Care prescribing different treatment plans that can include:
- Prescription pain medication, corticosteroids, and non-steroidal anti-inflammatory drugs
- Bisphosphonates to reduce bone changes
- Drugs for neuropathic pain conditions
- Topical ointments, sprays, and creams
- Rehabilitation and physical therapy
- Graded motor imagery
- Transcutaneous electrical nerve stimulation
- Spinal cord stimulation
- Sympathetic nerve block
When is surgery recommended for Complex Regional Pain Syndrome or CRPS?
Surgical procedures are only considered as an option in the most severe CRPS cases. For example, if the condition is a result of a compressed nerve caused by carpal tunnel syndrome, then the Neurosurgeon or Orthopedist may recommend surgery to release the pressure on the nerve. This may include a upper thoracic or lumbar surgical sympathectomy – In this procedure, a portion of the sympathetic nerve trunk is surgically destroyed (by cutting, burning, or clipping).
If CRPS is not diagnosed and treated in a timely manner, it can cause long-term disabilities and complications in the form of:
- Atrophy or tissue wasting and deterioration of skin, muscles, and bones
- Tightening of muscles to a point where the toes and fingers may take a fixed position
How can Complex Regional Pain Syndrome or CRPS be prevented – what precautions can you take?
The pain from Complex Regional Pain Syndrome is often even more severe than the pain of amputation, childbirth, or cancer. Due to the condition being so broad-based and with so many characteristic symptoms, there are not many effective ways to prevent or cure it. However, taking some basic precautions can help reduce the chance of developing CRPS:
For more information on Complex Regional Pain Syndrome, call 512-244-4272 to schedule an appointment with one of our Neurosurgeons OR Integrated Pain Management specialists at Advanced Pain Care. You can also schedule an online appointment at https://austinpaindoctor.com/locations
FAQS
Q: What is Complex Regional Pain Syndrome (CRPS)?
A: CRPS is a type of long-lasting pain that usually starts after an injury, surgery, or trauma. The pain may continue even after the original problem has healed. Many people also notice swelling, skin changes, or that the affected area feels much more sensitive than usual.
Q: What are the symptoms of CRPS?
A: People often describe CRPS pain as burning, deep aching, or throbbing. The area may hurt more than expected, even with a gentle touch. Swelling, stiffness, changes in skin color, and difficulty moving the affected limb can also happen.
Q: Is there a cure for CRPS?
A: There is no guaranteed cure for CRPS, but treatment can help reduce pain and improve movement. The aim is to help you manage symptoms and maintain daily activities as much as possible. Complex regional pain syndrome treatment may include medicines, nerve blocks, physical therapy, and spinal cord stimulation.
Q: How long does CRPS last?
A: CRPS does not have the same timeline for everyone. Some people improve within months, while others may continue to experience symptoms for a longer period. At Advanced Pain Care, complex regional pain syndrome doctors plan treatment according to how your pain, movement, and symptoms are affecting you.
Q: What is the difference between CRPS Type 1 and Type 2?
A: The difference comes down to nerve injury. In Type 1, there is no confirmed damage to a specific nerve. In Type 2, a particular nerve has been injured. The symptoms can feel very similar in both types.
Q: How is CRPS diagnosed?
A: There is no one test that simply says, “This is CRPS.” CRPS specialists usually diagnose it by listening to your symptoms, analyzing the affected area, and looking at changes like sensitivity, swelling, and movement.
Q: Can CRPS spread to other parts of the body?
A: In some people, CRPS symptoms may appear in other areas as well. This does not happen to everyone. Any new pain or changes should be discussed with your CRPS doctor.
Q: Is CRPS a disability?
A: For some people, CRPS can make everyday activities difficult because of ongoing pain and movement problems. Whether it is considered a disability depends on how much it affects your normal life.
Q: What triggers CRPS or causes a CRPS flare-up?
A: A flare-up can happen after things like physical stress, an injury, surgery, overdoing an activity, or even changes in weather. Everyone has different triggers. At Advanced Pain Care, understanding these patterns helps in planning better pain care.
Q: Does CRPS show up on an MRI or X-ray?
A: MRI or X-rays may show changes that are sometimes seen in CRPS, but they cannot confirm the diagnosis by themselves. CRPS specialists use your symptoms, examination findings, and test results together to understand the condition.
