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Complex Regional Pain Syndrome

more about Complex Regional Pain Syndrome

CRPS, reflex sympathetic dystrophy, RSD, Causalgia, Shoulder-hand syndrome, or Sudeck's atrophy.

  • Complex regional pain syndrome (CRPS) is a chronic pain syndrome, usually involving one leg or an arm.

  • The symptoms vary in severity and duration. The pain is usually localized to the injured arms or legs, but CRPS can affect any part of the body.
    1. The main symptoms include throbbing, burning pain and a tingling sensation. This severe pain is often accompanied by extreme sensitivity to a light touch in the affected area of skin.
    2. The symptoms of acute stages (first 3 to 6 months) are characterized by swelling, tenderness, excessive sweating, heat sensation, and skin color change (reddish, mottled) in the affected area. After the acute period, the skin becomes cool and bluish in some patients. Other changes include a thickening of skin tissue, relief from swelling and heat sensation. In the later periods, joint stiffness along with contracture and thinning of the skin, subcutaneous areas, and muscle tissue can be seen. However, the course of the disease is different from person to person.

  • The mechanism of pain is uncertain. CRPS develops after a wide variety of tissue injuries, including bone fractures, soft tissue trauma, and stroke. CRPS can also occur after minor injuries.

  • The diagnosis is based on the history of injury, symptoms, and signs.
  • Radiologic tests are supportive:
    1. Simple X-Rays of the affected area showing bone loss (osteoporosis) in the later stages
    2. Bone scan

  • There is no single treatment that cures complex regional pain syndrome (CRPS)
  • The response of patients to therapy is varied.
    1. Corticosteroid (Prednisone) -- short-term therapy with Prednisone may result in early remission of CRPS in some patients.
    2. Drugs for pain control -- various drugs are used to relieve pain from CRPS, including anti-seizure medications, antidepressants, and opioids.
    3. Physical therapy relieves the swelling and prevents contracture.
    4. Sympathetic nerve blocks -- injection of local anesthetics to the sympathetic nerves in the neck (stellate ganglion) or lower back (lumbar sympathetic nerve blocks)
    5. Lumbar sympathectomy -- destruction of the sympathetic nerve to get longer pain relief than a nerve block would provide.

  • Early treatment is most effective. If started within 3 months of the onset, the prognosis is a positive one. About 50 to 60 % of all CRPS patients have significant chronic pain that lasts for over 6 months.

more about Complex Regional Pain Syndrome

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