Complex Regional Pain Syndrome

What is Complex Regional Pain Syndrome?

Complex Regional Pain Syndrome (CRPS), previously called “reflex sympathetic dystrophy” or “causalgia,” is a chronic pain condition that is believed to be the result of dysfunction in the central or peripheral nervous systems. Typical features include dramatic changes in the color and temperature of the skin over the affected limb or body part, accompanied by intense burning pain, skin sensitivity, sweating, and swelling. Eventually the joints become stiff from disuse, and the skin, muscles, and bone atrophy.

What are the Symptoms of CRPS?

The key symptom of CRPS is continuous, intense pain out of proportion to the severity of the injury which gets worse rather than better over time. CRPS most often affects one of the extremities (arms, legs, hands, or feet). In many cases CRPS has 3 stages. Often, however, CRPS does not follow this progression. Some people go into the later stages almost immediately while others may always remain in Stage 1.

Stage 1 (lasts 1-3 months):

• Severe burning, aching pain increasing with the slightest touch or breeze
• Swelling with warmth or coolness
• Skin becomes dry and thin, changes color
• Increased nail and hair growth
• Pain may move further up or down the affected limb

Stage 2 (lasts 3-6 months):

• Swelling spreads
• Noticeable changes in skin texture and color
• Decreased hair growth
• Changes in bone seen in x-rays
• Stiff muscles and joints

Stage 3 (irreversible changes become evident):

• Pain may exist in the entire limb
• Permanent tissue changes
• Muscle wasting
• Limited mobility in limb
• Contractions involving muscles and tendons

What Causes CRPS?

Physicians aren’t sure what causes CRPS. Many times CRPS develops after a wide variety of tissue injuries, including bone fractures, soft tissue trauma, and crushing injuries. CRPS can also occur after minor injuries.

How is CRPS Diagnosed?

CRPS is diagnosed primarily through observation of the signs and symptoms. But because many other conditions have similar symptoms, it can be difficult for doctors to make a firm diagnosis of CRPS early in the course of the disorder when symptoms are few or mild. Some physicians apply a stimulus (such as touch, pinprick, heat, or cold) to the area to see if it causes pain. Doctors may also use triple-phase bone scans to identify changes in the bone and in blood circulation.

How is CRPS Treated?

Because there is no cure for CRPS, treatment is aimed at relieving painful symptoms so that people can resume their normal lives. The following treatments are often used; physical therapy, psychotherapy, sympathetic nerve block, medications, surgical sympathectomy, spinal cord stimulation, and intrathecal drug pumps.

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