Treating Complex Regional Pain Syndrome

Have you been dealing with abnormal pain or other troubling symptoms following physical trauma or surgery? Do you feel like your injury should be healed already, but the symptoms only keep getting worse?

Your symptoms may be due to a relatively rare condition known as complex regional pain syndrome (or CRPS). CRPS occurs when your nerves become damaged as the result of an injury. In this blog post, we’ll discuss why treating CRPS early improves your chances of experiencing a successful recovery.

WHAT IS COMPLEX REGIONAL PAIN SYNDROME (CRPS)?

CRPS is a blanket term that describes prolonged or excessive pain and inflammation that follows an injury or trauma. The symptoms associated with CRPS can be either short-term or chronic. However, it’s generally believed that CRPS is associated with improper functioning of the nerves that carry relay messages to the brain.

Symptoms of Complex Regional Pain Syndrome

CRPS typically occurs in an arm or leg that has suffered a trauma. Symptoms may come and go or be present for extended periods of time. Warning signs of CRPS may include:

• Spontaneous nerve pain, burning, squeezing, or “pins and needles” sensations that affect a portion or all of a limb
• Increased sensitivity in the area such that even a light touch or normal contact causes excessive or prolonged pain
• Fluctuations in skin color, temperature, or swelling in the affected limb
• Abnormal patches of sweating or lack of sweating from the limb
• Changes in skin texture due to a lack of oxygen and nutrients being delivered to the area
• Abnormal nail and hair growth—either rapid hair growth or none at all
• Swelling, damage, or stiffness in the joints
• Muscle tremors, spasms, or weakness
• Reduced ability to move the affected limb

CRPS can affect anyone at any age. That being said, it is more commonly seen in women and middle-aged individuals.

What Causes Complex Regional Pain Syndrome?

To better understand CRPS, we need to understand how the central nervous system works. The central nervous system consists of the brain, spinal cord, and nerves that spread throughout the body. Specifically, your brain sends signals to these nerves to control your body. These signals travel through the spinal cord to the appropriate nerve receptors, initiating action.

The nerves also transmit messages back to the brain. Thus, everything we feel is the result of the brain interpreting a signal sent by the nerves.

This complicated communication system is responsible for…well, everything. From taking a breath to running a marathon, your central nervous system plays a key role.

As nerves are located farther from the spinal cord, they get thinner. For example, the thinnest nerve fibers lack a protective coating known as the myelin sheaths. As a result, they are more likely to become injured.

Injuries to these nerves are suspected to be the cause of up to 90% of all CRPS cases. After all, these small nerve fibers play a role in how your arms and legs operate. They are responsible for transmitting and relaying messages about itch, pain, and temperature. They also control nearby small blood vessels and the health of surrounding cells.

When these small fibers are injured, it affects the way that they transmit messages to and from the brain about pain and sensation. This is at least partially why the symptoms of CRPS are so varied and change over time.

CRPS is divided into two types:

• Type 1 (formerly known as reflex sympathetic dystrophy) is the most common form of CRPS. Doctors label a patient as Type 1 when uncertainty exists about the exact nerve that was injured or the nerve itself wasn’t directly injured.
• Type 2 (formerly known as causalgia) occurs when a distinct nerve is noted as injured. Type 2 is associated with more extensive injuries in which nerves that feed the muscles are affected.

COMMON CAUSES OF INJURIES THAT CAN TRIGGER CRPS

In about 90% of cases, a prior injury or trauma is linked to the onset of complex regional pain syndrome. These injuries can include:

• Bone fractures: The most common injury related to CRPS. A broken, splintered, or displaced bone can injure nearby nerves.
• Casting/limb immobilization: Caring for a bone fracture can also lead to CRPS. Tight and painful casts, as well as long periods of resting the limb affect blood flow and how the nerves typically function.
• Sprains/strains: Injuries to the ligaments and tendons may cause the joints to move more than usual. As a result, nearby nerves can become stretched out or irritated.
• Surgery: Nerve damage during the surgical process is always a possibility. Even when a surgery goes well, CRPS can develop.
• Burns, cuts, or penetrations: These lesser injuries still have the potential to affect the underlying nerves.

Also, certain medical conditions, behaviors, and even family history can make a person more likely to develop CRPS after an injury. For example, smoking can slow nerve regeneration. Diabetes, an inactive lifestyle, and receiving chemotherapy can all also affect the nerves.

If you suffered an injury or trauma and are experiencing the symptoms mentioned above, you are probably wondering if you have complex regional pain syndrome. How do you know for sure? And, more importantly, what CRPS treatments are available?

Let’s take a closer look…

DIAGNOSING & TREATING COMPLEX REGIONAL PAIN SYNDROME

There’s no doubt that the symptoms of CRPS can affect the quality of your life. And, unlike some other health conditions, the answers are a little more complicated. If you suspect you have CRPS, the sooner you talk to your doctor or a specialist, the more likely you’ll be to experience positive outcomes.

How is CRPS Diagnosed?

There is no test that can single-handedly diagnose CRPS. Typically, the process of diagnosing CRPS starts with a review of medical history and a detailed physical examination by a physician, neurologist, or orthopedist.

Certain tests can help doctors diagnose CRPS and rule out any other medical conditions. These tests include:

• X-rays can detect loss of minerals in the bones often associated with later stages of CRPS.
• A bone scan can alert doctors to changes in the bones like bone resorption—when bone tissue breaks down and is absorbed back into the body.
• Magnetic resonance imaging (MRI) may show bone and bone marrow abnormalities, which can assist in identifying an injured nerve.
• Sweat production tests that measure the amount of sweat on both limbs can determine if there is uneven sweating—an indicator of CRPS.
• A nerve conduction study may detect CRPS-associated nerve injuries.

Treating Complex Regional Pain Syndrome

After being diagnosed with CRPS, you’re probably wondering…what’s next? And the answer may not be that straightforward. In many cases, a combination of treatments—based on your specific situation—is necessary.

Treatment options for CRPS include:

MEDICATIONS

Several types of medications have demonstrated proven efficacy in treating CRPS symptoms—especially when the condition is detected early. However, no medications have been approved by the FDA specifically for CRPS. Meaning, there is no combination of drugs that is guaranteed to be effective for everyone.

Nonetheless, a doctor or pain management specialist familiar with CRPS may suggest or prescribe the following medications:

• Acetaminophen (aka, Tylenol) can reduce pain related to inflammation in the bones and joints.
• Non-steroidal anti-inflammatory drugs (NSAIDs), like aspirin or ibuprofen, also can assist with moderate pain and inflammation.
• Topical anesthetic ointments, creams, and sprays (such as lidocaine) can prevent pain due to touch or other stimuli that don’t normally provoke pain.
• Prescription pain medications, like opioids or fentanyl patches, can be effective when over-the-counter pain relievers don’t work. These medications, however, can become habit-forming and need to be taken exactly as prescribed.
• Corticosteroids, such as prednisone, help reduce swelling and inflammation, often restoring mobility to an affected area.
• For severe cases, botulinum toxin injections (Botox) can relax contracted muscles, thus restoring normal positions in the limbs.
• Sympathetic nerve-blocking medications may be injected to block pain fibers in damaged nerves.
• Intravenous ketamine, a strong anesthetic administered in low doses, can significantly reduce pain associated with CRPS.
• If bone loss is detected, medications like alendronate and calcitonin can stall or prevent further bone loss.

Therapies for CRPS

If medications alone don’t prove effective for treating CRPS symptoms, other therapies have shown promising results for some patients. Viable treatment options may include:

• Rehabilitation & physical therapy: Learning how to keep a painful limb moving helps improve blood flow and reduces symptoms. Rehabilitation also encourages strength, flexibility, and normal function in an affected limb.
• Spinal cord stimulation: A minor surgery in which electrodes are inserted near the spinal cord. The electrical stimulation blocks pain sensations and normalizes the nerves’ communication to and from the brain. Once the stimulator is implanted, an external controller can turn it off and on as well as adjust the amount of electrical stimulation.
• Transcutaneous electrical nerve stimulation (TENS): A method of electrical stimulation that uses electrodes on the surface of the skin. The low voltage current stimulates the affected nerves to block or change your perception of pain.
• Transcranial Magnetic Stimulation (rTMS): Instead of electrical currents, rTMS uses a magnetic field to change signaling in the brain.
• Medication pumps: Implanted devices that deliver medications directly into the spinal cord fluid. Since the medications are pumped directly to the nerves, lower doses can be used. This typically results in fewer side effects and better efficacy.
• Alternative/holistic therapies: Alternative therapies may not address the source of CRPS, but can improve an individual’s quality of life and decrease some of their symptoms. Alternative therapies may include relaxation techniques, acupuncture, and chiropractic care.

Addressing the Emotional Issues Associated with CRPS

CRPS can affect your mental health, too. Symptoms, treatments that aren’t working as hoped, or even misdiagnosis can leave you feeling frustrated or hopeless. Needless to say, your physical health and mental health are closely related.

If CRPS symptoms are causing an emotional impact, you may want to consider talking to a therapist or joining a support group. Sharing your frustrations and learning coping skills can help you cope with the emotional aspects of CRPS.

LET’S TALK SOLUTIONS FOR YOUR COMPLEX REGIONAL PAIN SYNDROME

Integrated Pain Consultants is an experienced, award-winning group of pain specialists. Our team has numerous combined decades of education and experience in treating painful conditions and helping others return to a better life.

If you’re wondering why you’re feeling pain, want a second opinion, or desire more effective treatment options, schedule a consultation today.

Remember: Treating complex regional pain syndrome is easier when diagnosed and treated early. So let’s get started now!