Complex Regional Pain Syndrome (CRPS) is a chronic pain condition that frequently affects a limb following an injury or after surgery. CRPS is believed to be caused by damage to the peripheral and central nervous systems. Symptoms of CRPS include burning pain, swelling of the limb, sensitivity in the extremity, skin color changes, temperature changes, and reduced strength.
The location is usually the arm or leg, but CRPS can occur anywhere. The resulting pain is often longer in duration or greater in intensity than what would usually be expected for a level of injury. CRPS often occurs after trauma or surgery. The cause is often disproportionate response of the sympathetic nervous system to fractures, crush injuries, sprains, or surgery. However, in about 10% of patients, there is no specific incident that causes CRPS.
CRPS has two subtypes, Type I and Type II.
- Type I (also known as reflex sympathetic dystrophy) includes patients who do not have damage to their peripheral nerves. Peripheral nerves transmit information from the brain and spinal cord to different parts of the body, and vice versa.
- Type II (also known as causalgia) occurs in patients who have peripheral nerve damage.
Symptoms of CRPS include:
- Burning, stinging, or tearing pain
- Changes in sensation (abnormally increased sensitivity or tenderness)
- Reduced strength in the affected part of the body
- Differences in skin temperature, skin color, sweat, or swelling
A diagnosis of CRPS is suspected when:
- The aforementioned symptoms develop after limb trauma, usually within 4-6 weeks
- Symptoms are disproportionate to the initial trauma (persist longer, or are more intense than is typical)
- Symptoms “travel” beyond the region involved in the trauma
Treatment options for CRPS
- Lumbar Sympathetic Block – Injection of local anesthetic and steroid around a nerve plexus, which interrupts the pain pathway and stops the pain cycle.
- Medication management
- Spinal Cord Stimulation
- The above interventions are often combined with physical/occupational therapy. The goal of treatment is to allow the patient to participate actively in a rehabilitation regimen and to reduce pain, restore movement, and improve strength of the affected limb.
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