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What is Complex Regional Pain Syndrome (CRPS)?
Complex Regional Pain Syndrome (CRPS) is a rare disorder that is also known as Reflex Sympathetic Dystrophy (RSD). It is an exaggerated response from the nervous system after tissue damage or injury. It commonly occurs in the extremities and more in the upper than lower extremities. Complex Regional Pain Syndrome is classified into two categories depending on whether direct nerve injury was involved.
CRPS Type I: this type was formerly known as Reflex Sympathetic Dystrophy and occurs after tissue damage with no known nerve involvement
CRPS Type II: known previously as Causalgia, this type of Complex Regional Pain Syndrome is diagnosed when it occurs after an established trauma to a nerve
What Causes CRPS?
While it is unclear what causes the nervous system to overreact in this way, the conditions and risk factors that may lead to this condition in the hand and/or wrist are:
- Trauma to the wrist or hand, fractures being the most common cause of a CRPS response
- Other traumas to the body such as heart attacks, surgery, and infections
- Soft tissue injuries such as sprains and strains
- Strokes, which cause widespread damage to the nervous system, are a factor of developing a form of Complex Regional Pain Syndrome known today as Shoulder-Hand Syndrome
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Symptoms of CRPS
This disorder is a difficult one to diagnose and usually ends up being a diagnosis of exclusion as there is no specific diagnostic test that exists for this. The symptoms that will lead a practitioner to suspect CRPS as a diagnosis are:
- A throbbing pain in your wrist or hand
- Pain associated with allodynia (this means sensitivity to something that would not ordinarily cause pain, such as putting on a shirt or brushing your hair)
- Sensitivity to heat and cold and abnormal skin temperatures, temperature asymmetry (one limb that is hotter or colder than the other)
- Changes of skin texture, abnormal growth of skin or hair
- Stiffness in joints and loss of range of motion and problems with coordination of movements
- Swelling
- Increased sweating
- Unnatural movements in affected area, such as jerking motions, tremors, or an abnormal posture
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Treatment for CRPS
Treatment for CRPS is extremely individualized. Increasing the associated pain must be balanced with exercises that are necessary to prevent a future decrease in loss of range of motion and function. Physical and occupational therapy will often be utilized as a first line of defense in order to preserve flexibility of musculature and surrounding structures. Exercise also helps to facilitate and improve blood flow and lessen any circulatory problems. Along with therapy, some additional intervention methods used for this condition are:
- Pain medications and NSAIDs are often prescribed, however there is no medication that is approved specifically for treatment of this condition
- Botulinum Toxin injections
- Corticosteroids
- Topical anesthetic creams
- Sympathetic nerve blocks
- Spinal cord stimulation which involves the implantation of an electric stimulator inside the body near the spinal cord that can be turned on and off in order to interrupt pain signals
- Intrathecal drug pumps which deliver pain medication directly to the fluid surrounding the spinal cord
