Complex Regional Pain Syndrome (CRPS), formerly known as Reflex Sympathetic Dystrophy (RSD), is a complex and often misunderstood and misdiagnosed chronic pain condition that can develop after an injury or trauma to a limb. It manifests with a variety of symptoms that can range from mild discomfort to severe, unrelenting pain.

​

Understanding CRPS

• CRPS typically affects one limb, most commonly an arm, leg, hand, or foot. It's characterized by:

  • intense burning pain

  • swelling

  • stiffness

  • changes in skin color and temperature.

  • increased sensitivity to touch or temperature changes.

  • abnormal sweating over area may occur

These symptoms often worsen over time and can spread to other parts of the body.

The exact cause of CRPS is not fully understood, but it is believed to involve abnormal nervous system responses to injury or trauma. It can occur after surgeries, fractures, sprains, or even minor injuries. 

​

Diagnosing CRPS can be challenging as there is no specific test for it. Diagnosis:

• medical history

• physical examination

• ruling out other possible conditions.

• Imaging tests such as X-rays, MRI, or bone scans may be ordered to assess the extent of tissue damage and rule out other conditions.

​​

Pain Specialists use something called the Budapest Criteria to evaluate for the possibility of CRPS. 

In the Budapest Criteria the following criteria must be met:

1) Continuing pain, which is disproportionate to any inciting event.

2) The patient must report at least one symptom having occurred since onset in three of the four following categories:

1. Sensory

   • An extreme sensitivity of the skin of the area affected.  Sometimes patients cannot tolerate clothing touching the area.  The sensitivity is similar to a severe sunburn​

2. Vasomotor

   • Reports of temperature asymmetry, that the affected area feels hotter or colder than other areas

   •  skin color changes

     • red (erythema) or​

     • blue (cyanotic)

3. Sudomotor/Edema:

   • swelling (edema) of the affected area

   • abnormal sweating of the affected area

4. Motor/Trophic:

   1. decreased range of motion

   2. and/or motor dysfunction

      1. (weakness, tremor, spasm)

   3. and/or trophic changes

      1.  abnormal patterns of growth of hair, nail, or skin.

3) Must display at least one sign at time of evaluation in two or more of the following categories:

1. Sensory: Pain with light touch or movement of the area

2. Vasomotor: Evidence of temperature asymmetry (>1 °C) and/or skin color changes and/or asymmetry.

3. Sudomotor/Edema: Evidence of edema and/or sweating changes and/or sweating asymmetry.

4. Motor/Trophic: Evidence of decreased range of motion and/or motor dysfunction (weakness, tremor, dystonia) and/or trophic changes (hair, nail, skin).

4) There is no other diagnosis that better explains the signs and symptoms.

​

​

Once diagnosed, the goal of treatment for CRPS is to alleviate pain, improve function, and enhance quality of life.

Treatment plans are often multidisciplinary, involving a combination of medications, physical therapy, psychological support, and interventional procedures.

​

Medications:  Medications are typically prescribed to help manage pain and inflammation associated with CRPS. These may include:

• Over-the-counter pain relievers like acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) may be recommended for mild to moderate pain.

• Antidepressants and nerve stabilizers: Certain antidepressants and anticonvulsant medications can help alleviate neuropathic pain associated with CRPS.

• Muscle relaxants

​​

Physical Therapy:  Physical therapy plays a crucial role in CRPS management by helping improve mobility, strength, and flexibility. Physical therapists can design personalized exercise programs tailored to the individual's specific needs and abilities. Techniques such as gentle stretching, massage, and desensitization exercises can help reduce pain and improve function over time.

​

Psychological Support:  Living with chronic pain can take a toll on mental health, leading to anxiety, depression, and stress. Psychological support, such as cognitive-behavioral therapy (CBT) or counseling, can help individuals cope with the emotional challenges of CRPS. Learning relaxation techniques, stress management strategies, and mindfulness meditation can also be beneficial in managing pain and improving overall well-being

​

Interventional Procedures: For individuals with severe or refractory CRPS symptoms, interventional pain management procedures may be recommended. These procedures target the nerves or affected tissues to block pain signals and provide relief. Some common interventional treatments for CRPS include:

• Sympathetic nerve blocks:  These involve injecting local anesthetics or medications directly into the sympathetic nerves to block pain signals.

• Spinal cord stimulation (SCS):  SCS involves implanting a device near the spinal cord that delivers electrical impulses to interrupt pain signals before they reach the brain.

• Intrathecal drug delivery:  This involves implanting a pump under the skin that delivers pain-relieving medications directly into the spinal fluid

 

 Complex Regional Pain Syndrome is a challenging condition that can significantly impact quality of life.  However, with a comprehensive treatment approach that addresses both physical and psychological aspects of pain, many individuals with CRPS can experience significant improvement in symptoms and function. It's essential for individuals living with CRPS to work closely with a multidisciplinary team of healthcare professionals to develop a personalized treatment plan tailored to their specific needs and goals. By raising awareness and understanding of CRPS, we can better support those affected by this complex chronic pain condition.