Complex regional pain syndrome

Description

Complex regional pain syndrome (CRPS) is a form of chronic pain that usually affects an arm or a leg. complex regional pain syndrome (CRPS) usually develops after an injury, a surgery, a stroke or a heart attack. The pain is out of proportion to the severity of the initial injury.

CRPS is uncommon, and its cause is not clearly understood. The treatment is most effective when started early. In such cases, improvement and even remission are possible.

Symptoms

The signs and symptoms of CRPS include:

  • Continuous burning or throbbing pain, usually in the arm, leg, hand or foot
  • Sensitivity to touch or cold
  • The swelling of the painful area
  • The changes in the temperature of the skin — alternating between sweaty and cold
  • Changes in the color of the skin, ranging from white and mottled to red or blue
  • Changes in the texture of the skin, which may become tender, thin or shiny in the affected area
  • Changes in hair and nail growth
  • Stiffness of joints, swelling, and damage
  • Muscle spasms, tremors, and weakness (atrophy)
  • Decreased ability to move the affected body part

The symptoms may change over time and vary from person to person. Pain, swelling, redness, noticeable changes in the temperature and hypersensitivity (especially to cold and touch) usually occur for the first time.

Over time, the affected limb can become cold and pale. It is possible that undergo skin and nail changes, as well as muscle spasms and tightening. Once these changes occur, the condition is often irreversible.

CRPS can occasionally spread from its origin to other parts of the body, such as the opposite limb.

In some people, the signs and symptoms of PCI away on its own. In others, the signs and symptoms can persist for months or years. It is likely that the treatment will be more effective when initiated early in the course of the disease.

When to see a doctor

If you experience constant, severe pain that affects a limb and makes touch or move that limb seems intolerable, talk to your health care provider to determine the cause. It is important to treat CRPS early.

Causes

The cause of CRPS is not fully understood. It is believed that it is caused by an injury or difference in the central and peripheral nervous systems. CRPS typically occurs as a result of a trauma or an injury.

CRPS occurs in two types, with similar signs and symptoms, but different causes:

  • Type 1. Also known as reflex sympathetic dystrophy (RSD), this type occurs after an illness or injury that does not directly damage the nerves in the affected limb. About 90% of people with CRPS type 1.
  • Type 2. Once referred to as causalgia, this type has symptoms similar to those of type 1. But type 2 CRPS occurs after a clear nerve injury.

Many cases of PCI occur after a strong trauma to an arm or a leg. This may include a crushing injury or fracture.

Other major and minor trauma, such as surgery, heart attacks, infections and even sprained ankles — can also lead to the PCI .

It is not known very well why these injuries can be triggered CRPS . Not everyone who has an injury, you will develop CRPS . It could be due to an interaction between the central and peripheral nervous system that is not typical, and different inflammatory responses.

Complications

If CRPS is not diagnosed and treated early, the disease can progress to more-disabling signs and symptoms.

  • Tissue wasting (atrophy). The skin, bones, and muscles start to deteriorate and weaken if you avoid or have difficulty moving an arm or a leg because of pain or stiffness.
  • Muscle tightening (contracture). You can also experience the tightening of the muscles. This can lead to a condition in which the hand and fingers of the hands or the feet and toes contract in a fixed position.

Prevention

These steps can help reduce the risk of developing PCI :

  • Taking vitamin C after a wrist fracture. Studies have shown that people who take a high dose of vitamin C after a wrist fracture may have a lower risk of PCI in comparison with those who did not take vitamin C.
  • Early mobilization after stroke. Some research suggests that people who get out of bed and walking soon after a stroke (early mobilization) to reduce your risk of developing CRPS .

Complex regional pain syndrome

Diagnosis

The diagnosis of complex regional pain syndrome (CRPS) is based on a physical exam and medical history. There is No single test that can definitively diagnose PCI , but the following procedures can provide important clues:

  • Bone scan. This procedure can help to find changes in the bone. A radioactive substance is injected into your veins allows your bones to be seen with a special camera.
  • The sweat of the production test. Some tests can measure the amount of sweat on both limbs. Disparity of results may indicate the CRPS .
  • The x-ray. loss of mineral from the bones may appear in an x-ray at later stages of the disease.
  • Magnetic resonance imaging (MRI). The images captured with a Magnetic resonance image (MRI) of the test may show changes in the tissue to rule out other conditions.

Treatment

There is some evidence that early treatment can help to improve the symptoms of CRPS . Often, a combination of different treatments, tailored to your specific case, it is necessary to. The treatment options include:

Drugs

Doctors use several medications to treat the symptoms of the PCI .

  • Pain relievers.The analgesics available without a prescription, such as aspirin, ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) — may relieve mild pain and inflammation. Your doctor may prescribe stronger pain relievers if over-the-counter (OTC) ones are not useful. Opioid medications may be an option. Taken in low doses, may help control the pain.
  • Antidepressants and anticonvulsants. Sometimes antidepressants, such as amitriptyline, and anticonvulsants, such as gabapentin (Gralise, Neurontin), are used to treat pain that originates from a damaged nerve (neuropathic pain).
  • Corticosteroids. Steroid medications, such as prednisone, can reduce inflammation and improve mobility in the affected limb.
  • Bone-loss medications. Your doctor may suggest medications to prevent or stop bone loss, such as alendronate (Binosto, Fosamax) and calcitonin (Miacalcin).
  • Sympathetic nerve-blocking medication. The injection of an anesthetic to block pain fibers in the affected nerves, may relieve pain in some people.
  • Ketamine intravenously. Some studies show that low doses of ketamine intravenously, a strong anesthetic, which substantially relieve the pain.
  • Medicines to lower blood pressure. Sometimes, high blood pressure medicines, including prazosin (Minipress), phenoxybenzamine (Dibenzyline), and clonidine may help control the pain.

Pain relievers. The analgesics available without a prescription, such as aspirin, ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) — may relieve mild pain and inflammation.

Your doctor may prescribe stronger pain relievers if over-the-counter (OTC) ones are not useful. Opioid medications may be an option. Taken in low doses, may help control the pain.

Therapies

  • The heat therapy. The application of heat may offer relief of swelling and discomfort in the skin that feels fresh.
  • Topical pain relievers. Various topical treatments are available that can reduce hypersensitivity, such as capsaicin cream available without a prescription, or lidocaine cream or patches (Lidoderm, ZTlido, other).
  • Physical or occupational therapy. Soft, guided by the exercise of the affected limbs or modification of daily activities can help to decrease pain and improve range of motion and strength. The earlier the disease is diagnosed, the more effective exercises could be.
  • The mirror therapy. This type of therapy uses a mirror to help trick the brain. I was sitting in front of a mirror or the mirror box, move the healthy limb, so that the brain perceives as the limb affected by CRPS . The research shows that this type of therapy may help to improve function and reduce pain for people with PCI .
  • Transcutaneous electrical nerve stimulation (TENS). Chronic pain is sometimes relieved by the application of electrical impulses to the nerve endings.
  • Biofeedback. In some cases, the learning of the techniques of biofeedback can help. In biofeedback, you learn to become more aware of your body so that you can relax the body and relieve the pain.
  • Stimulation of the spinal cord. Your doctor will insert tiny electrodes over the spinal cord. A small electrical current delivered to the spinal cord results in the relief of pain.
  • Infusion pumps intrathecal. In this therapy, medications that relieve pain is pumped, the fluid of the spinal cord.
  • Acupuncture. Inserting long, thin needles, can help to stimulate nerves, muscles and connective tissue to increase blood flow and relieve the pain.

It is possible for the CRPS is repeated, sometimes due to a trigger, such as exposure to cold or emotional stress. Recurrences can be treated with a small dose of an antidepressant or other medications.

Coping and support

Living with a chronic, painful condition can be a challenge, especially when — as is often the case with the PCI — your friends and family do not believe that you can feel as much pain as you describe. Share information from reliable sources about the CRPS with people close to you to help you understand what you are experiencing.

Follow these suggestions to take care of your physical and mental health:

  • Keep typical of the daily activities in the best possible way.
  • Pace yourself and make sure you get the rest you need.
  • Stay connected with friends and family.
  • Continue hobbies that you like to and are able to do.

If the CRPS makes it difficult for you to do things that you enjoy, ask your healthcare provider about ways to get around the obstacles.

Keep in mind that your physical health can directly affect your mental health. The denial, the anger, and frustration are common with chronic diseases.

Sometimes, you may need more tools to deal with their emotions. A therapist, psychologist, behavioral, or other professional may be able to help you put things in perspective. He or she may also be able to teach coping skills, such as relaxation or meditation techniques.

Sometimes joining a support group where you can share experiences and feelings with other people, it is a good approach. Ask your doctor about support groups are available in your community.

Preparing for your appointment

To get the best medical attention, take the time to prepare for your appointment.

What you can do

Write down any symptoms you're experiencing — including the severity and location of your pain, stiffness or tenderness. It is also a good idea to write down any questions that you have for your provider.

Examples of questions that you can ask your provider include:

  • What is the likely cause of my symptoms?
  • What kind of evidence, if any, do I need to do?
  • Is my temporary condition or possibly chronic?
  • What types of treatments are there? Which would I recommend?
  • What are the alternatives to the primary approach you're suggesting?
  • I have these other health conditions. How can I best manage them together?
  • Is there a generic alternative to the medicine you're prescribing for me?
  • Are there brochures or other printed material that I can take home? What sites do you recommend?

In addition to the questions that you've prepared to ask your doctor, do not hesitate to ask questions during your appointment.

What to expect from your doctor

Your provider is likely to ask a series of questions. Be prepared to respond to them can stop the time to go through any of the points that you want to devote more time. For CRPS , your provider may ask:

  • Has recently had an accident, injury or illness, such as trauma to their extremities, of a heart attack or an infection?
  • You have recently had surgery?
  • When did you first begin experiencing pain or burning?
  • How long have you been experiencing symptoms?
  • The pain is occasional or continuous?
  • Nothing seems to improve or worsen your symptoms?
  • Has experienced similar symptoms after the wounds of the past?
Symptoms and treatment of Complex regional pain syndrome