Complex Regional Pain Syndrome

What is Complex Regional Pain Syndrome?

Complex Regional Pain Syndrome (CRPS), also known as Reflex Sympathetic Dystrophy, is a chronic condition which is characterized by intense pain in the extremities. The pain is usually not proportional to injuries sustained, and may continue to worsen over time. It may be brought on by painful or non-painful stimuli. The first stage of CRPS includes increased sensitivity and muscle weakness, followed by swelling, hair loss, ulcers, and vascular system changes. There is no cure for CRPS, though if discovered early it can usually be controlled with nerve blocks. Occasionally the patient will experience spontaneous remission. Otherwise treatment focuses on pain relief, from medications such as antidepressants, opioids, and corticosteroids to spinal cord stimulation and physical therapy.

What are some of the specific treatments for CRPS?

1. Physical therapy.
Physical therapy is key at all stages for patients with CRPS. It is important for patients to mobilize the affected extremity to help reduce long-term changes such as muscle weakness, decreased blood flow.

2. Pain relief is also a top priority for patients. Medical management, nerve blocks, electrical stimulation techniques (TENS unit, acupuncture), and spinal cord stimulation are examples of commonly used modalities. Medical management will typically include low dose antidepressants, nonsteroidal anti-inflammatory medications, anti-convulsants, alpha blockers. Narcotic medical management is only indicated in select cases.

3. Because CRPS can be a very debilitating condition, patients will often experience depression and other emotional disturbances. Psychological and psychiatric evaluation in treatment is necessary and patients who exhibit depressive and emotional disturbances or who have had the condition for a long period of time without improvement. Stress management techniques such as pacing, hypnosis, relaxation, cognitive and behavioral therapy can be very useful in helping patients to better deal with their pain. In addition, patients being considered for narcotic management should also receive psychological evaluation.