Understanding Complex Regional Pain Syndrome
Complex regional pain syndrome (CRPS) happens when you experience intense, prolonged pain after an injury to an arm or a leg. It’s estimated that CRPS affects almost 200,000 people in the United States each year.
There are two types ofCRPS.
- Type 1: Pain occurs in the absence of known nerve damage.
- Type 2: Pain occurs after a confirmed nerve injury.
Continue reading to learn more about the disease and how it is treated.
CRPS symptoms often come on about 1 month after an injury to the affected limb.
The most common symptom ofCRPS is pain that is much more intense than it should be. You may experience this pain.
- stinging
- burning
- A person is stabbed.
- tearing
- squeezing
You may notice other changes in the limb that is affected by theCRPS.
- numbness and tingling, or a “pins and needles” sensation
- increased sensitivity to pain (allodynia)
- “Severe pain is caused by things that aren’t very painful.”
- Weakness or a reduced range of motion are problems with movement.
Acute and chronic CRPS symptoms
Acute and chronic symptoms of the disease can happen.
The acute phase is also referred to as the “warm” phase and happens early on. It’s characterized by deeper pain that gets worse with movement, as well as classic symptoms of inflammation in the affected limb, such as:
The chronic phase (or “cold” phase) starts
- a grayish or bluish appearance to the skin
- The skin is cold and clamminess is present.
- The skin texture can change in which it may appear shiny and thin.
- Changes in the growth of hair and nails can be seen.
- muscle tremors or spasms
- osteoporosis that affects nearby bones
There are two types ofCRPS.
- Type 1 CRPS: No specific nerve injury can be found. This type used to be called reflex sympathetic dystrophy.
- Type 2 CRPS: A known nerve injury is causing the symptoms. This type used to be called causalgia.
Whether the exact nerve injury is found or not,
Unlike other nerves in your body, the type of nerve fibers damaged in CRPS don’t have a protective myelin sheath. This makes them more prone to harm. These nerve fibers are important for a variety of functions, such as:
- Sending pain and temperature messages from your limbs to your brain.
- controlling blood flow in the limb
- communicating with immune cells
When damage happens, the nerve fibers and tissues that they interact with may not function as they should, leading to symptoms ofCRPS. There are injuries that can lead toCRPS.
- There are bone breaks.
- There are strains or sprains.
- burns
- There are cuts.
- There are injuries to the body.
- limb immobilization, such as when the limb is placed in a cast
- surgery
Some people do not develop the disease, while others do. Various factors are likely involved.
There are no recommended treatments for the disease. Treatment usually aims to alleviate symptoms and restore function to the limb.
The treatments used forCRPS can be a combination of the following.
- Physical therapy: A physical therapist will work with you to improve the function of your limb without making your symptoms worse. This may involve:
- Physical therapy exercises help strengthen your muscles.
- Mirrors and graded motor imagery aim to retrain your brain in order to reduce pain and improve movement.
- The affected limb is desensitized to various sensations.
- Occupational therapy: An occupational therapist can help you develop strategies for better using your affected limb in daily activities.
- Neuropathic pain medications: Medications can also ease nerve pain associated with CRPS. Some medications that may be used include:
- epilepsy drugs like gabapentin and pregabalin
- tricyclic antidepressants like amitriptyline and nortriptyline
- Anti-inflammatory medications: Nonsteroidal anti-inflammatory drugs or corticosteroids can help reduce inflammation associated with CRPS.
- Bisphosphonates: Medications called bisphosphonates can reduce bone changes that happen with CRPS.
- Psychotherapy: Living with CRPS can cause mental and emotional strain, potentially leading to anxiety or depression. Psychotherapy can be beneficial in helping you cope.
- Nerve stimulation: If medications don’t reduce pain, nerve stimulation may help. This treatment involves using a device to send electrical signals to the affected nerves. It may include stimulation of the spinal cord, peripheral nerves, or other nerves.
Treatment is generally
The cause ofCRPS is not known, but some factors appear to increase the risk of developing the disease after an injury.
- Sex: CRPS is more common in individuals assigned female at birth. Some research has found that this population is
four times more likely to be diagnosed with CRPS. - Age: CRPS appears to happen more frequently in people in early middle age. Most people are diagnosed
around age 40 . - Injury location: Injuries to the hand or arm appear to be more commonly involved in CRPS.
- Type of injury: Fractures are the
most common type of injury associated with CRPS. Higher impact injuries, such as those sustained in a car accident or a fall, also appear to increase the risk of CRPS. - Other disorders: Research suggests that a history of certain disorders may be associated with an increased risk of CRPS, including:
“It doesn’t mean you’ll develop the condition after an injury. It means you may be at an increased risk for the disease compared with other people.”
“When you feel excessive pain in a limb after an injury, it’s called a case of chronic pain syndrome.”
If you have severe symptoms, the condition can have a long-term impact.
Recovery may take longer if you have problems with nutrition. Smoking, diabetes, and previous chemotherapy can prolong recovery.
If you start treatment soon after symptoms start, the outlook is better. If you have recently had a limb injury and are still having pain that is more intense than usual, you should make an appointment with a doctor.