COMPLEX REGIONAL PAIN SYNDROME (CRPS)
WHAT IS IT? (DEFINITION)
Complex regional pain syndrome (CRPS) is the current description of an uncommon but severe, chronic pain condition that can be triggered by a minor injury (or can even occur spontaneously). This condition has specific features and characteristics and is associated with significant disability, a reduced quality of life and has a variable progress.
DID YOU KNOW?
CRPS could be considered one of the few pain conditions where you can actually see the pain. That is in this condition the hand or foot or other part of the body will swell up, change colour and feel a different temperature.
IS IT COMMON? (INCIDENCE)
It occurs in about 5:100,000 people. The upper limbs are generally more affected than lower limbs. The arm is affected in 60% of cases and the leg in 40%. It can affect more than one limb and can even appear on the opposite limb.
WHO GETS IT? (EPIDEMIOLOGY)
Females are affectde 4 times more often than male. Any age group can be affected, even children. It usually occurs a minor injury like a fractured wrist but it can occur following almost any injury even a sprain. In 10% of cases it can occur spontaneously.
WHAT DOES IT FEEL LIKE? (SYMPTOMS AND SIGNS)
Most people with CRPS report a mix of symptoms. There is usually intense burning pain with severe skin sensitivity. Sometimes even lightly touching the skin with cotton wool can be felt as severe pain. The hand or foot can also look abnormal. It can be swollen, and look red or even white. The joints can be stiff or frozen. The nails and hair can even grow differently when compared to the other side.
WHAT CAUSES IT? (PATHOPHYSIOLOGY)
Although we are not exactly sure why CRPS occurs, there seems to be an excessive inflammation in the area. Nerves can become inflamed. Even the spinal cord can become inflamed. The brain and other nerves can become sensitised, which means that they are triggered by minor irritations and then send excessive pain signals to the brain. Some people may be genetically predisposed to getting CRPS.
WHAT HAPPENS BECAUSE OF IT? (CONSEQUENCES)
Uncontrolled or poorly managed pain can have many consequences. Some consequences can be easily managed but others require specialist management.
Pain leads to fear of moving so people reduce or stop moving. This leads to deconditioning. Deconditioning is a complex problem that follows a period of inactivity, bed rest or even just a sedentary lifestyle. Deconditioning causes a decline in physical, functional, psychological, and even social aspects of life. Deconditioning leads to weak muscles, stiff joints, reduced coordination, weak bones, poor sleep, high blood pressure. This can go on to cause depression, anxiety, low self-confidence and inability to enjoy life. This is called the downward spiral of chronic pain.
In short, uncontrolled pain is exhausting, physically and mentally and emotionally.
HOW DO YOU DIAGNOSE IT? (DIAGNOSTIC TESTS)
Recently, a clear set of criteria has been developed to diagnose CRPS. These are called the Budapest criteria. Your pain specialists will use these criteria to help make the diagnosis of CRPS. If a diagnosis can be made them certain treatments can be considered.
HOW DO YOU TREAT IT? (TREATMENTS)
Treatment involves a number of different options that your pain specialist will consider and discuss with you. The overall purpose is to provide you with meaningful pain reduction so that you can start moving that part of the body.
Pain reduction approaches can include:
- Medications like anti-epileptics, antidepressants, ketamine, lignocaine, muscle relaxants, steroids, bisphosphonates, capsaicin and other pain creams.
- Advanced pain interventional treatments can be very useful. Nerve blocks and injections can be used. These include sympathetic blocks, stellate blocks, botox.
- Neuromodulation and spinal cord stimulation has been shown to be effective in treating CRPS. Some consider that this treatment should be used earlier in this pain condition.
- Rehabilitation approaches that are aimed at getting the limb moving again include –physiotherapy, occupational therapy and psychology approaches to help coping.
HOW DO YOU PREVENT THIS CONDITION? (PREVENTION)
High dose of Vitamin C can prevent this problem in some people. Most pain specialists will advise taking 500mg of Vitamin C daily for two months following a minor injury of the wrist.
If you have any questions, just ask.
- Birklein F, O'Neill D, Schlereth T. Complex regional pain syndrome: An optimistic perspective. Neurology. 2015 Jan;84:89-96. LINK
- Marinus J, Moseley GL, Birklein F et al. Clinical features and pathophysiology of complex regional pain syndrome. Lancet Neurol. 2011;10:637-48. LINK
- Song JJ, Popescu A, Bell RL. Present and potential use of spinal cord stimulation to control chronic pain. Pain Physician. 2014;17:235-46. LINK