(CRPS; Reflex Sympathetic Dystrophy [RSD]; Causalgia; Sympathetically Maintained Pain)
Definition
Definition
Complex regional pain syndrome (CRPS) refers to a chronic condition that affects the nerves and blood vessels of 1 or more limbs.
There are 2 types of CRPS:
- CRPS 1, previously called reflex sympathetic dystrophy or RSD, has no observable nerve damage.
- CRPS 2, previously called causalgia, produces similar symptoms after a verified nerve injury has occurred.
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Causes
Causes
The cause of CRPS is not known. The condition likely results from several factors. It may involve overactivity of the sympathetic nervous system. Inflammation may also play a role in the disorder.
Risk Factors
Risk Factors
Factors that may increase your risk of CRPS include:
Symptoms
Symptoms
Symptoms usually appear after an injury. The most important symptom of CPRS is prolonged pain that may be constant or severe. Pain is typically described as burning, throbbing, aching, squeezing, or shooting.
Symptoms of CRPS change over time and may include:
- Sensitivity to touch or even a light breeze
- Swelling in the arm or leg
- Unusual sweating patterns
- Excessively warm or cool skin
- Hair and nails that become brittle and crack
- Abnormal movement in the arm or leg, such as a tremor, jerking, or spasms
- A pale, blue, and/or shiny look to the skin
- Limited joint movement
Diagnosis
Diagnosis
You will be asked about your symptoms and medical history. A physical exam will be done. You may be referred to a pain specialist.
Images may be taken of your bodily structures. This can be done with:
The electrical activity in your nerves and muscles may need to be tested. This can be done with:
You may need to have your body’s heat measured. This can be done with a thermogram.
You may need to have your autonomic nervous system evaluated. This can be done with quantitative sudomotor axon reflex test (QSART), resting sweat output (RSO), or the resting skin temperature (RST).
Treatment
Treatment
Treatment aims to relieve pain and improve function. Early therapy may lead to better outcomes. In some cases, the condition goes away on its own; this is more common in children. Talk with your doctor about the best treatment plan for you. Options include:
Physical and Occupational Therapy
Physical and occupational therapy may help reduce pain and increase mobility.
Counseling
Long-term pain often leads to depression or anxiety. Counseling is often required to help patients deal with chronic pain and loss of function.
Cognitive behavioral therapy may help you manage pain. It is a form of talk therapy that focuses on how the way you think affects the way you feel and act.
Medications
Your doctor may advise the following medications:
- Pain relievers
- Topical pain relievers that are applied to the skin
- Bisphosphonates
- Antiseizure medications
- Corticosteroids
Surgery
A surgical procedure called sympathectomy can permanently destroy sympathetic nerves. In some cases however, surgery may worsen symptoms.
Other Treatments
A device may be implanted in your spine. It will deliver electric stimulus to your spinal cord to manage pain.
Prevention
Prevention
There are no known ways to prevent CRPS.
RESOURCES:
Reflex Sympathetic Dystrophy Syndrome Association http://www.rsds.org
CANADIAN RESOURCES:
References:
http://www.ebscohost.com/dynamed
Updated November 19, 2014. Accessed June 4, 2015.
Complex regional pain syndrome fact sheet. National Institute of Neurological Disorders and Stroke website. Available at:
http://www.ninds.nih.gov/disorders/reflex_sympathetic_dystrophy/detail_reflex_sympathetic_dystrophy.htm
Updated February 23, 2015. Accessed June 4, 2015.
Harden RN, Bruehl SP. Diagnosis of complex regional pain syndrome: signs, symptoms, and new empirically derived diagnostic criteria. Clinical Journal of Pain. 2006;22:415-419.
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4/24/2014 DynaMed’s Systematic Literature Surveillance
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Wise JN, Weissman BN, et al. American College of Radiology (ACR) Appropriateness Criteria for chronic foot pain. Available at: http://www.acr.org/~/media/ACR/Documents/AppCriteria/Diagnostic/ChronicFootPain.pdf. Updated 2013. Accessed June 4, 2015.
Last Updated: 6/18/2014