Complex Regional Pain Syndrome

Complex Regional Pain Syndrome Overview

Complex Regional Pain Syndrome (CRPS) is a condition that causes pain, changes in skin color and texture, and other symptoms in a particular part of the body, often the extremities. Therefore, this can be experienced in your arm, leg, hand, or foot.

There is currently no known cause for Complex Regional Pain Syndrome; however, it is believed that CRPS originates from a dysfunction in your central or peripheral nervous systems. Your central nervous system is your brain and spinal cord, while your peripheral nervous system relays the information from your brain and spinal cord to your organs, arms, legs, fingers, and toes.

Therefore, it’s believed that the sensitivity to the pain you feel in your extremities can be the result of the overreaction of the pain signals that your body can’t turn off. CRPS can go away on its own, and potentially last a short period of time. However, CRPS symptoms can be long-term (over six months) and CRPS symptoms can reoccur. 

It’s estimated that about 10% to 30% of people who initially experience CRPS experience a recurrence. The cause for the recurrence is unknown. Therefore, seeking early, effective pain management treatment options is essential to improve your CRPS symptoms.

There are two subtypes of Complex Regional Pain Syndrome: Type I and Type II.

Type I CRPS

otherwise known as reflex sympathetic dystrophy (RSD), develops without nerve damage. This occurs after an illness or other injury that didn’t damage a nerve. It’s estimated that 90% of people with CRPS experience Type 1.

Type II CRPS

Type 2 CRPS, otherwise known as causalgia, develops after specific nerve damage/ injury. 

This distinct nerve damage can be from a variety of circumstances like sudden trauma to the arm or leg, a sprained ankle, injection, surgery, or any case that involves negatively impacting a specific nerve/nerves.

Causes 

Although the exact cause of CRPS is unknown, researchers think CRPS is the result of dysfunction in your central or peripheral nervous systems. Furthermore, 90% of CRPS cases result from some type of nerve trauma or injury to the affected limb before CRPS symptoms develop. 

While this doesn’t account for the cause of the 10% of cases of people who seemingly develop CRPS without exact cause, this does suggest that severe physical trauma or injury can play a role in developing CRPS.

Common injuries that are often linked to CRPS cases include:

• Bone Fracture, especially wrist fracture
• Surgery
• Sprains or strains
• Burns, bruises, or cuts

There are specific risk factors that may increase your chance of developing CRPS. These risks include:

• Poor Nerve Health: If you have diabetes, this can decrease your nerves' ability to repair themselves from damage. Peripheral neuropathy is another condition that can make it difficult for nerve cells to regrow following an unexpected injury (i.e. sudden physical trauma). Likewise, those with a history of smoking or having undergone chemotherapy are another sign of poor nerve health.
• Immune System Issues: CRPS is more prevalent in those who have inflammatory or autoimmune diseases. This is because the immune system is linked to inflammation and often CRPS have heightened levels of inflammatory chemicals that trigger common CRPS symptoms.
• Genetics: Researchers have found some connection between genetics and CRPS. Your genes influence your body’s recovery from injury. And, since CRPS is often associated with injury/ sudden physical trauma, this could explain why some people who experience such injuries do (or do not) experience CRPS symptoms.

Other demographic trends in CRPS cases include the condition being more common in adults (about 40 years of age) than children. CRPS also affects more females than men. And, a majority of CRPS cases (66% to 80%) involve people of European ancestry.

Prevention & Risks to Avoid

Although the root cause of CRPS remains largely unknown, several preventative measures are recommended to lower your risk of CRPS. For instance, certain lifestyle factors like smoking and poor management of health conditions (i.e. diabetes) can prevent your nerves from healing efficiently. 

Meanwhile, it’s believed that taking Vitamin C before surgery or after a wrist fracture might prevent CRPS. Also, it is believed that early mobilization after a stroke (i.e. getting out of bed and walking around) can lower your risk of developing CRPS.

Symptoms

It’s essential to seek treatment as soon as possible to effectively improve your CRPS symptoms. Some of the common symptoms of CRPS include:

• Throbbing pain in your arm, leg, hand, or foot
• Sensitivity to touch or cold
• Swelling of the affected area
• Fluctuating skin temperature (i.e. warm to cold)
• Changes in skin color (i.e. from white to red or blue)
• Muscle spasms
• Reduced mobility of the affected area
• Changes in hair or nail growth
• Joint stiffness or swelling

Although symptoms vary on an individual basis, key symptoms like pain, swelling, and temperature sensitivity are common CRPS symptoms that first appear.

As the condition develops, symptoms like the affected area appearing pale and cold to the touch, noticeable skin or nail changes and muscle spasms are all later symptoms that can appear if left untreated.

Unfortunately, once these later symptoms develop, they are typically irreversible. Therefore, early treatment is crucial.

It’s important to note that CRPS can be acute (short-term) or chronic (symptoms last over six months). No matter if your symptoms disappear on their own, it’s important to see your healthcare provider to help improve your symptoms early on.

Development of CRPS Symptoms 

As discussed, CRPS symptoms, if left untreated, can develop into worsening symptoms that can leave irreversible damage to your body. That’s why seeking treatment as early as possible is critical so you can live a happy, healthy quality of life.

Since CRPS is rare, it can be difficult to accurately spot all the signs and symptoms of the condition.

Below are the three stages of CRPS symptom development to be aware of as the condition progresses.

Stage 1 (1-3 months after the initial onset of CRPS)

• Burning or aching pain that worsens at even the slightest touch to the affected area
• Frequent changes in skin temperature from noticeably hot to cold, and back again
• Changes in hair and nail growth
• Muscle spasms 
• Joint pain
• Changes in your skin, such as in the color or texture

Stage 2 (3-6 months after the onset of CRPS)

• Pain worsens
• Nails weaken and become brittle and cracked
• Joint stiffness
• Muscles weaken

Stage 3 (6 months after the onset of CRPS)

• Muscles and tendons waste (atrophy)
• Contractures of the affected area

Often, after the six-month mark of suffering from CRPS symptoms, changes are permanent.

Complications

If Complex Regional Pain Syndrome is left undiagnosed and untreated, the symptoms inevitably worsen and can progress to life-altering symptoms like:

• Spread of Condition: CRPS symptoms can spread from initially a localized area of the body to become more widespread if left untreated. 
• Tissue Wasting (atrophy): The deterioration of the skin, bones, and muscles due to a lack of movement in the affected area. This lack of movement is because of the pain or stiffness felt when you attempt to move that area of the body.
• Muscle Tightening (contracture): Tightening of the muscles such that the affected area becomes contracted into a fixed position, resulting in a lack of normal movement.

Diagnosis of Complex Regional Pain Syndrome

CRPS is rare; therefore, this condition is often misdiagnosed. There is no clear identifier or test that can be done to diagnose CRPS. 

Often, your doctor will diagnose complex regional pain syndrome by evaluating your past medical history, physical exam, and current symptoms. 

A doctor may ask about any recent injury, surgery, or sudden physical trauma that may have led to your symptoms. Your doctor may also observe your affected skin for changes in appearance, temperature, and texture. Likewise, they may observe if the pain you are experiencing is higher than normal from a particular injury or surgery.

Certain imaging tests like an ultrasound or magnetic resonance imaging (MRI) can also be used to look for signs of nerve damage; however, sometimes nerve damage may not be visible. Electromyography (EMG) can also be done to eliminate the potential for other conditions causing your pain, like neuropathy.

Treatment Options 

There is no cure for CRPS. Yet, there are a wide variety of treatment options that can help relieve your CRPS symptoms, slow down the progression of the disease, and ultimately help the individual manage their pain better to get back to leading a normal, healthy life.

Noninvasive treatment options are often the first course of action to reduce CRPS symptoms. 

Some noninvasive treatment options include: 

• Medication: There are a variety of drugs that can help relieve CRPS symptoms. This can include both prescription drugs and non-prescription pain medication. Examples of common medications include steroids to reduce inflammation, drugs to reduce the progression of bone loss, and antidepressants.
• Physical Therapy: Physical therapy in learning guided exercises to improve your affected area’s mobility and flexibility is another common treatment option. 
• Counseling/ Talk Therapy: Counseling can help with depression and anxiety that can accompany those suffering from CRPS.

While the above noninvasive treatment options are one of the first steps an individual can do to treat their CRPS symptoms, sometimes those options above may not be enough to manage a patient’s CRPS symptoms alone. 

The Pain and Spine Specialists offer a variety of treatment options to better manage your CRPS symptoms. This includes treatments such as:

• Medication Management 
• Intrathecal Pump
• Radiofrequency Ablation
• Peripheral Nerve Stimulation 
• Trigger Point Injections
• Spinal Cord Stimulation  (Read Our Latest Blog) 

CRPS Treatment Specialists

The Pain and Spine Specialists our an advanced team of pain specialists including CRPS doctors Maryland, Virginia, and Pennsylvania. We aim to provide comprehensive pain management treatment options especially tailored to better manage your chronic pain.

You can also schedule your complex regional pain syndrome treatment Maryland today by scheduling your appointment here.

Don’t live near one of our three pain management clinics? Research “complex regional pain syndrome doctors near me” so you can get the help you need to improve your quality of life today.