Chronic Pain as a Symptom – Understanding CRPS

Superior Diagnosis and Treatment of Complex Regional Pain Syndrome

Are you experiencing unexplained moderate-to-severe pain and seeking to find the cause? You may have been on a long journey for a concrete diagnosis. Perhaps your physician suggested that your symptoms could possibly be due to CRPS–Complex Regional Pain Syndrome.

There are a number of conditions that have serious, chronic pain as a symptom, along with others that are also present in CRPS.  Let us show you  more about this condition and its symptoms to help you rule it in–or out.

What is CRPS?

Complex Regional Pain Syndrome is a chronic pain condition most often affecting one of the limbs (arms, legs, hands or feet), usually after an injury or trauma to that limb.  CRPS is believed to be caused by damage to, or malfunction of, the peripheral and central nervous systems.  CRPS occurs when the nervous system and the immune system malfunction as they respond to tissue damage from trauma.  The nerves misfire, sending constant pain signals to the brain.  The level of pain often measures as one of the most severe. CRPS generally follows a musculoskeletal injury, a nerve injury, surgery or immobilization.  The persistent pain and disability associated with CRPS require coordinated, interdisciplinary, patient-centered care to achieve pain reduction/cessation and better function.

Early diagnosis is the key to the best outcomes.  However, diagnosing CRPS is not an easy fete and many patients search for months or years for a definitive diagnosis.

CRPS is an actual physical disorder; unfortunately, it has not been unusual for medical professionals to suggest that people with CRPS exaggerate their pain for psychological reasons.  Trust your body and continue to seek a diagnosis.  If it is in fact, complex regional pain syndrome, the pain is NOT in your mind!

Who can get CRPS?

Anyone can have CRPS.  It can strike at any age and affects both men and women, although it is much more common in women.  The average age of affected individuals is about age 40.  CRPS is rare in the elderly.  Children normally do not get it before age 5 and only rarely before age 10 but it is common in teenagers.

What are the symptoms of CRPS?

The key symptom is prolonged pain that may be constant and, in some people, extremely uncomfortable or severe.  The pain may feel like a burning or “pins and needles” sensation, or as though someone is squeezing the affected limb.  The pain can spread to include the entire arm or leg, even though the precipitating injury might have been only to a finger or toe.  Pain can sometimes even travel to the opposite extremity.  There is often increased sensitivity in the affected area, such that even light touch or contact is painful.  You can experience constant or intermittent changes in temperature, skin color, and swelling of the affected limb.  This is because of the abnormal microcirculation caused by damage to the nerves controlling blood flow and temperature.  An affected arm or leg may feel warmer or cooler compared to the opposite limb.  The skin on the affected limb can change color, become blotch, blue, purple pale or red.  You can also encounter the following:

• Changes in skin texture of the affected area
• Abnormal sweating pattern in the affected area or surrounding areas
• Changes in nail and hair growth patterns
• Stiffness in affected joints
• Problems coordinating muscle movement, with decreased ability to move the affected body part
• Abnormal movement in the affected limb, most often fixed abnormal posture but also tremors in or jerking of the affected limb

How is CRPS diagnosed?

There is no single diagnostic test to confirm CRPS.  Diagnosis is based on the affected individual’s medical history and signs/symptoms that best fit the definition.  But because several other conditions can cause similar symptoms, careful examination is important.  Since most people improve gradually over time, diagnosis can be more difficult later in the course of the disorder.  The distinguishing feature of CRPS is usually a history of earlier injury to the affected area, as most of these other conditions are not triggered by injury.  Individuals without a history of injury should be carefully examined to make certain that another treatable diagnosis is not missed.  The experts will insure to take all of the necessary steps to appropriately diagnose and treat the cause of your discomfort.

How is CRPS treated?

• Rehabilitation therapy. An exercise program to keep the painful limb or body part moving can improve blood flow and lessen the circulatory symptoms.  Additionally, exercise can help improve the affected limb’s flexibility, strength and function.  Rehabilitating the affected limb also can help to prevent or reverse the secondary brain changes that are associated with chronic pain.  Occupational therapy can also offer comfort as you learn new ways to work and perform daily tasks.
• CRPS and other painful and disabling conditions are associated with profound psychological symptoms for affected individuals and their families.  People with CRPS may develop depression, anxiety, or posttraumatic stress disorder, all of which heighten the perception of pain and make rehabilitation efforts more difficult.  Treating these secondary conditions is important for helping people cope and recover from CRPS.
• Several different classes of medication have been shown to be effective for CRPS, particularly when early in the course of the disease.  Your physician can offer you an individualized treatment plan to alleviate the pain.  Drugs often used to treat CRPS include:
  • Non-steroidal anti-inflammatory drugs to treat moderate pain, including over-the-counter aspirin, ibuprofen and naproxen
  • Corticosteroids that treat inflammation/swelling and edema, such as prednisolone and methylprednisolone (used mostly in the early stages of CRPS)
  • Drugs initially developed to treat seizures or depression but now shown to be effective for neuropathic pain, such as gabapentin, pregabalin, amitriptyline, nortriptyline and duloxetine
  • Botulinum Toxin Injections
  • Opioids such as oxycontin, morphine, hydrocodone, fentanyl and vicodin
  • NMDA receptor agonists such as dextromethorphan and Ketamine
  • Nasal Calcitonin, especially for deep bone pain
  • Topical local anesthetic creams and patches such as lidocaine
• Sympathetic nerve block. Some people report temporary pain relief from sympathetic nerve blocks, but there is no published evidence of long-term benefit.  Sympathetic blocks involve injecting an anesthetic next to the spine to directly block the activity of sympathetic nerves and improve blood flow.
• Surgical sympathectomy. The use of this operation that destroys some of the nerves is controversial.  Some experts think that is is unwarranted and couple make CRPS worse; others report favorable outcomes.  Sympathectomy should only be used in individuals whose pain is dramatically relieved (albeit temporarily) by sympathetic nerve blocks.  It also can reduce excess sweating.
• Spinal Cord Stimulation. Placing stimulating electrodes through a needle into the spine near the spinal cord provides a tingling sensation in the painful area.  Typically the electrode is placed temporarily for a few days to assess whether stimulation will be helpful.
• Intrathecal drug pumps. These devices pump pain-relieving medications directly into the fluid that bathes the spinal cord, typically opioids and local anesthetic agents such as clonidine and baclofen.  The advantage is that pain-signaling targets in the spinal cord can be reached using doses far lower than those required for oral administration, which decreases side effects and increases drug effectiveness.

What is the prognosis?

The outcome of CRPS varies from person to person.  Almost all children and teenagers have good recovery.  Some individuals are left with unremitting pain and crippling, irreversible changes despite treatment. Early treatment, particularly rehabilitation, is helpful in limiting the disorder.  We are the board-certified experts and we are sincerely committed to facilitating your pain-free life.  Take the time to discuss your symptoms with your Summit Pain Alliance Specialist and always remember to write down any questions prior to the visit. We enjoy assisting our patients to live an optimally balanced and pain-free lives.