Complex Regional Pain Syndrome

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Complex regional pain syndrome (CRPS) is a chronic neuropathic pain disorder that generally affects one of the limbs (arms, legs, hands, or feet) following an accident or trauma. Light skin contact, for example, is generally painless but generates high pain perception in CRPS sufferers. Normal painful stimuli, such as a pinprick, hurt more than they should due to the extreme discomfort (hyperalgesia). After a limb injury or surgery, CRPS generally affects just one limb. Due to the distress, persons with CRPS usually have restricted use of their afflicted limbs. Other indications and symptoms of CRPS, especially in its early stages, include warm, red, and swollen extremities on the afflicted side and enhanced pain sensitivity. Physical and occupational therapy are often used to treat CRPS, and the patient will almost always need medication or other treatments to control the pain.

Types of CRPS

Complex Regional Pain Syndrome (CRPS) is divided into two forms, each having similar indications and symptoms but distinct causes:

Type 1: Also known as reflex sympathetic dystrophy syndrome, this type develops after an illness or accident that doesn’t alter the nerves in the afflicted limb. Type 1 diabetes affects about 90% of persons with complicated regional pain syndrome.

Type 2: Also known as causalgia, this type of pain occurs after specific nerve damage. Many complicated regional pain syndrome cases develop after a solid trauma to an arm or a leg, such as a crush injury, fracture, or amputation. Complex regional pain syndrome may also be caused by other major and minor traumas, such as surgery, heart attacks, infections, and even sprained ankles. Emotional tension might also be a contributing cause. It’s unclear why these injuries cause complicated regional pain syndrome. Still, it might be related to a faulty interplay between your central and peripheral nervous systems and improper inflammatory reactions.

Symptoms & Signs

People with CRPS experience pain as the most prevalent and visible symptom. The pain is usually felt deep inside the limbs and is accompanied by a burning, stinging, or ripping feeling. Increased sensitivity to painful stimuli, perceiving pain from incentives that are typically non-painful, and, in some instances, the sensory loss is all frequent sensory alterations (e.g., numbness).

In addition to discomfort, patients often report a warm, red, and swollen afflicted extremity, at least at first. As CRPS progresses, the afflicted extremities may become colder, with dark or blue skin. Swelling caused by fluid build-up in the limb (edema) may occur independently of the color or temperature of the skin. However, it is usually more noticeable in the early stages of the disease (red and warm skin). Even over short periods, skin color and warmth may vary unpredictably. CRPS sufferers may have skin that becomes thin and glossy and increased or reduced hair and nail development in the afflicted extremities and the alterations listed above.

Most patients will have a motor impairment, which reduces their ability to move their limbs, with weakness or restricted range of motion being the most prevalent impairments. The limitations might be evident as a loss of strength in the handgrip or when standing on tiptoe. Certain people may have spasms or uncontrolled muscular contractions (dystonia).

Causes

The specific etiology of complex regional pain syndrome is unknown. However, numerous variables are believed to have a role in its development.

For injuries such as broken bones or fractures in the limb, immobilization (e.g., casting) to restrict the stem from moving to enable it to recover is a typical therapy. Patients with CRPS type I were more likely to have a history of immobilization in adults and children, which was linked to worsening symptoms. Immobilization of limbs following fractures or surgery causes increased sensitivity to pain, edema, and a rise in temperature in the afflicted limb. This shows that immobility may contribute to the disease’s progression.

Changes in the neurological system of the body might also contribute to CRPS. The sympathetic nervous system is an element of the nervous system. In “fight or flight” conditions, when the body is under much stress and has to be attentive, the sympathetic nervous system is engaged. The sympathetic nervous system constricts blood arteries to limit blood flow to the extremities during times of stress. Low sympathetic nervous system activity, on the other hand, promotes blood flow to the extremities. The sympathetic function may be reduced in the early stages of CRPS, contributing to heated, red, and swollen limbs. The sympathetic nervous system might play a role in the pain associated with CRPS. Although it is thought that the sympathetic nervous system may become connected to pain receptors in CRPS patients, it is still unknown how the sympathetic nervous system produces pain in these people.

What is the treatment for CRPS?

The following treatments are often used:

Rehabilitation therapy: Keeping the affected limb or body part moving with an exercise regimen might help increase blood flow and alleviate circulatory symptoms. Exercise may also improve the afflicted limb’s flexibility, strength, and function.

Medications: Several medications have been useful for CRPS, especially when administered early in the disease’s progression. Among the drugs used to treat CRPS are:

  • NSAIDs
  • Gabapentin, pregabalin, amitriptyline, nortriptyline, and duloxetine.
  • Injections of BOTOX
  • Morphine, tramadol, and fentanyl are examples of opioids.
  • Antagonists of the N-methyl-D-aspartate (NMDA) receptor, such as dextromethorphan and ketamine
  • Nasal calcitonin is used to treat deep bone pain. and
  • Lidocaine creams and patches are topical local anesthetics.

Physical therapy is a kind of treatment that involves keeping the body part moving and helps to heal by increasing circulation.

People who suffer from chronic pain are more likely to acquire mental health problems. Depression and anxiety are examples of them, and they have the potential to exacerbate discomfort. Psychotherapy may assist you in coping with your pain, and it also aids you in dealing with any situations that arise.

A nonsteroidal anti-inflammatory medicine (NSAID) may be recommended by your doctor (NSAID). This may assist with inflammation and discomfort. Aspirin (Bayer), ibuprofen (Advil, Motrin), and naproxen (Naprosyn) are among these medications (Aleve), and they may be purchased over the counter. Before using NSAIDs, see your doctor.

If your pain is severe, your doctor may prescribe nerve-blocking medications. Steroids may aid with swelling and discomfort, and some antidepressants and seizure medications may also assist with chronic pain. Narcotics and other pain relievers may not effectively treat CRPS discomfort, and it is sometimes essential to use a mix of medications.

Blocking the sympathetic nerves: An anesthetic (pain reducer) is injected into specific nerves, inhibiting the transmission of pain signals. It is possible to repeat the injection if it relieves the discomfort, and it is not a treatment.

The damaged nerve is a sympathectomy: The nerve chain will be severed or clamped by a surgeon, and this has been shown to help with the pain associated with CRPS.

Stimulation of the nervous system: Electrical or magnetic currents stimulate nerves. Some, like spinal cord stimulation, need minimal surgery.

A therapy that is effective for one individual may not be effective for another. Each person needs their treatment strategy.

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