If you have pain in your arm or leg that is not getting better, chances are you might have developed complex regional pain syndrome (CRPS). It is a condition that causes severe pain in either your arm or leg. Mostly, it is caused by trauma or injury to the arm or leg that affects the nerve. But it does not happen to everyone. If it’s not treated, the symptoms get worse and are hard to reverse. Learn about complex regional pain syndrome causes, symptoms, diagnosis, and treatment in this article. Visit the best Pain Management Clinic in Brooklyn at Doral Health & Wellness or log on to www.doralhw.org.
Causes & risk factors
The exact cause of complex regional pain syndrome (CRPS) is not well understood because, in some cases, the cause can be determined, while in others, it is not possible. It is not necessary that what triggers CRPS in one case will be the same in another case. Mostly, it occurs when trauma or injury affects your peripheral or nervous system. Several theories suggest how trauma or injury leads to chronic pain syndrome, including inflammation, nerve damage, and problems that work in the same way as nerves send signals to the brain.
It has two types, which cause similar symptoms but have different causes:
- Type 1: It is also known as reflex sympathetic dystrophy (RSD), which occurs when an illness or injury doesn’t directly damage the nerves of the affected limb. Around 90% of CRPS cases are of this type.
- Type 2: It is also known as causalgia, which causes similar symptoms to type 1. However, it occurs when a distinct nerve is damaged.
Most cases of CRPS occur after a forceful trauma to an arm or leg, including fractures, sprains, burns, cuts, etc. Other major and minor traumas include surgery, nerve damage, heart attacks, infections, etc. But not everyone with an injury will develop CRPS. It is still not clear how these injuries trigger CRPS. This might occur due to interaction between the central and peripheral nervous systems that isn’t typical and has different inflammatory responses.
Some people might be at a higher risk of getting CRPS following an injury than others, including women or people who get severe trauma, lower limb injury, especially the foot, or a work injury in a highly physical occupation. Additionally, people who get injured with pain much higher than normal or have sensory changes like allodynia are more likely to develop CRPS.
People who smoke or have poor circulation, have diabetes, autoimmune disorders, or have had past nerve damage are also at higher risk of CRPS. Genes play a significant role in a person’s likelihood of getting CRPS. Families and siblings of people with CRPS are more at risk of developing CRPS at an early age. A few genes that have been identified in families and populations affected by CRPS can be a contributing factor for them.
Symptoms
CRPS symptoms can vary between individuals; however, the most common symptom is pain, which can be continuous, come and go, or get worse when touched. Other symptoms may include:
- Continuous burning, stabbing, or throbbing pain, particularly in the arm, leg, hand, or foot
- Cold sensitivity
- Swelling in the painful area
- Skin temperature changes between sweaty and cold
- Skin color changes from white to blotchy to red or blue
- Skin texture changes, which may feel tender, thin, or shiny in the affected area
- Hair and nail growth changes
- Joint stiffness, swelling, or damage
- Muscle spasms, tremors, and weakness
- Lessened ability to move the affected part
These symptoms can change over time in different individuals. Typically, symptoms such as pain, swelling, redness, noticeable changes in temperature, and hypersensitivity occur first. Over time, the affected limb becomes cold and pale. It may undergo skin and nail changes along with muscle spasms and tightening. Once these symptoms happen, it becomes almost irreversible. CRPS may spread from its source to other parts of the body, like the opposite limb.
In some people, these symptoms get better on their own. In others, it may persist for months to years. Treatment is mostly effective when these symptoms start during its course.
Diagnosis
To diagnose CRPS, the doctor will perform a physical exam and ask questions related to your symptoms, lifestyle, and medical history. After that, they recommend several tests to confirm your condition:
- Bone scan: This test is done with the help of X-rays to check loss of minerals in the affected limb and determine whether it’s osteoporosis or other abnormalities. Sometimes, a radioactive substance is injected into one of your veins to get a clearer image of bones with a specialized camera to confirm the presence of CRPS in a limb.
- Blood tests: This is used to rule out infection or autoimmune conditions, such as rheumatoid arthritis.
- Nerve conduction studies: Doctors may give a regional or local anesthetic to see if CRPS is present, and/or if this block eases your pain.
- Ultrasound or MRI: These tests are used to rule out underlying nerve or tissue damage. Bone and bone marrow abnormalities are also checked on MRI, which helps to identify the CRPS-affected limb. Ultrasound may find localized tissue damage.
- Sweat production tests: These tests are used to measure the amount of sweat produced on both limbs. Uneven results may indicate CRPS.
The International Association for the Study of Pain uses a set of criteria called the Budapest criteria to diagnose CRPS. This examines your symptoms based on this account:
- Unusual sensitivity to touch
- Skin color or temperature is different between the affected limb and the normal one
- Swelling or unusual sweating in the affected limb
- Lower range of motion, functional loss, or changes in the hair, skin, or nails of the affected limb
Treatment
CRPS treatments vary in every individual; however, early intervention can lead to better outcomes. Usually, a combination of different treatments is used to treat CRPS. It includes:
Medications
The most common medications used to treat the symptoms of CRPS are:
- Pain relievers: The most common pain relievers that don’t need a prescription are aspirin, ibuprofen, and naproxen sodium to ease mild pain and inflammation. Stronger pain prescriptions with over-the-counter medications are not helpful. Opioid medications are also an option. Given in lower doses to manage pain.
- Antidepressants and anticonvulsants: These medications are also used to treat pain that occurs from a damaged nerve.
- Corticosteroids: Steroid medications such as prednisone are also used to lower inflammation and improve mobility in the affected limb.
- Bone-loss medications: These medications (including alendronate and calcitonin) help to prevent or stall bone loss.
- Sympathetic nerve-blocking medication: It is an anesthetic injection to block pain fibers from the affected nerves to give some relief to people.
- Intravenous ketamine: Some studies suggest that low doses of intravenous ketamine (a strong anesthetic) may relieve pain.
- Medicines to lower blood pressure: Sometimes, lower blood pressure medications such as prazosin, phenoxybenzamine, and clonidine can help manage blood pressure and pain.
Therapies
Along with medications, some therapies are also used to relieve pain:
- Heat therapy: Using heat to reduce swelling or discomfort on the skin.
- Topical analgesics: Various topical treatments are used to lower hypersensitivity, such as capsaicin cream, lidocaine cream, or patches.
- Physical or occupational therapy: These guided exercises help the affected limbs or modify the daily activities to lower pain and improve range of motion and strength. The earlier the disease is diagnosed, the more effective the exercise will be.
- Mirror therapy: This type of therapy uses a mirror to trick the brain. You need to sit in front of a mirror or mirror box, then move your healthy limb to make your brain perceive that limb is affected by CRPS. Research found that this type of therapy may improve function and lower pain in people.
- Transcutaneous electrical nerve stimulation (TENS): Sometimes, chronic pain gets relieved by blocking nerve signals with electrical impulses.
- Biofeedback: In some cases, biofeedback techniques can help you learn to become more aware of your body so that you can relax and relieve pain.
- Spinal cord stimulation: In this therapy, your doctor inserts tiny electrodes into the spinal cord to deliver a small amount of electrical current to relieve pain from the spinal cord.
- Intrathecal drug pumps: In this therapy, certain medications are pumped into the spinal fluid to relieve pain.
- Acupuncture: In this therapy, long, thin needles are inserted into the skin to stimulate nerves, muscles, and connective tissue to relieve pain and increase blood flow.
It’s possible that CRPS can recur, sometimes due to triggers such as exposure to cold or intense emotional stress. Its recurrence can be treated with antidepressants or other medications.
Complex regional pain syndrome is a condition that causes severe pain in the affected limbs. Its exact cause is not well understood, but trauma or injury to the nerve is the main cause. Its symptoms can vary in individuals, but pain is the main symptom. To diagnose complex regional pain syndrome, the doctor uses different tests and then treats this condition with medications combined with different therapies. The earlier you notice and start your treatment, the better the outcome will be.
Need help with CRPS? Visit our pain management clinic in Brooklyn to get professional medical help. Call us to book your appointment now!!! If you’re ready to take the next step in managing your pain, we recommend consulting with our healthcare provider to explore the right treatments or therapies for you. Always listen to your body and adjust your daily routine to prioritize your well-being. Visit Doral Health & Wellness Pain Relief Department in Brooklyn, to get professional help and guidance on how to manage your problem. Call us on + 1-718-367-2555 to get a consultation. If you need help learning coping methods, register your information and make direct contact with our doctors at https://yuz88hfiyh7.typeform.com/Doralintake. Log on to www.doralhw.org. Or visit us at 1797 Pitkin Avenue, Brooklyn, NY 11212.
