Complex Regional Pain Syndrome: A condition ruling the pain scale

Complex regional pain syndrome (CRPS) is the most painful medical condition known to man. It is a 45/50 on the McGill pain scale.

Because it is hard to find good doctors to treat this extremely painful condition, CRPS has a grim nickname: the “suicide disease”.

CRPS affects a person’s arm, hand, leg or foot. It occurs after an injury, such as a fracture. Though rarely, but it can affect other body parts such as the face.

Types of Complex Regional Pain Syndrome

A CRPS patient experiences burning pain 24/7, but during a flare-up, this pain will drastically increase to the point where the person cannot even stand to have his/her toes touching each other. The patient may be astonished by the fact there are no flames on his feet. In fact, the saying for CRPS is “burning for a cure”.

Orange is the awareness colour for CRPS, along with the orange ribbon and flames.

Source: Queensland times

There are two types of CRPS:

Type 1: An apparently trivial injury, such as a fractured or sprained ankle, has occurred, but with no confirmed nerve damage. This type was previously known as reflex sympathetic dystrophy.

Type 2: This may emerge after breaking a bone, having surgery, or after a serious infection. There is clear evidence of nerve damage. This type was previously known as causalgia.

Source: medical news today

However, debate about the classification of these types is ongoing. Since nerve injury is sometimes found in people with type 1, the National Institute of Neurological Disorders and Stroke (NINDS) notes that the distinction between the two categories may be removed at some point.

Some experts suggest that type 1 is not Complex Regional Pain Syndrome at all, but that it is either a normal reaction or the result of treatment received after a trauma.

Symptoms of CPRS

If CPRS is not diagnosed quickly, changes to the bone and muscle may get worse and may not be reversible. In some people, symptoms go away on their own.

You need to check for symptoms and consult a professional on time if you can tick any of the following:

  • Pain that is described as deep, aching, cold, burning, and/or increased skin sensitivity.
  • An initiating injury or traumatic event, such as a sprain, fracture or minor surgery that should not cause a pain as severe as the one being experienced. Or where the pain does not subside with healing.
  • Pain (moderate-to-severe) associated with allodynia, that is, pain from something that should not cause pain, such as the touch of clothing or a shower.
  • Continuing pain (moderate-to-severe) associated with hyperalgesia, that is, heightened sensitivity to painful stimulation.
  • Abnormal swelling in the affected area.
  • Abnormal hair or nail growth.
  • Abnormal skin colour changes.
  • Abnormal skin temperature, that is, one side of the body is warmer or colder than the other by more than 1°C.
  • Abnormal sweating of the affected area.
  • Limited range of motion, weakness, or other motor disorders such as paralysis or dystonia.

Symptoms and signs can affect anyone, but CRPS is more common in women, with a recent increase in the number of children and adolescents who are diagnosed.

CRPS affects people in different ways and one person’s response to treatment will be different from another person’s.

Source: Stephens law firm

Treatment of Complex Regional Pain Syndrome

Because CRPS can be hard to diagnose, your doctor may suggest you to see a specialist, such as a neurologist, rheumatologist, or pain specialist.

Since there is no cure for CRPS, the goal of treatment is to give relief gradually. Therapies include psychotherapy, physical therapy, and drug treatment, such as topical analgesics, narcotics, corticosteroids, antidepressants and anti-seizure drugs.

Other treatments include:

  • Sympathetic nerve blocks: These blocks, which are done in a variety of ways, can provide significant pain relief for some people. One kind of block involves placing an anesthetic next to the spine to directly block the sympathetic nerves.
  • Surgical sympathectomy: This controversial technique destroys the nerves involved in CRPS. Some experts believe it has a favorable outcome, while others feel it makes Complex Regional Pain Syndrome worse. The technique should be considered only for people whose pain is temporarily relieved by selective sympathetic blocks.
  • Intrathecal drug pumps: Pumps and implanted catheters are used to send pain-relieving medication into the spinal fluid.
  • Spinal cord stimulation: This technique, in which electrodes are placed next to the spinal cord, offers relief for many people with the condition.

A timeline of how CRPS may proceed

Even though complex regional pain syndrome most often appears after an injury, that isn’t the only cause. It also can be triggered by an infection, heart attack, stroke, cancer, neck problems, or pressure on a nerve.

Here is what you may experience through different phases of CRPS:

For the first three months: You feel burning pain, and the affected area is more sensitive to touch. Those are the most common early symptoms. Swelling and joint stiffness usually start next.

Three months to a year: Swelling is more lasting, and wrinkles in the skin go away. Pain spreads, and joints get stiffer.

A year or more: Skin becomes pale, stretched, and shiny. Pain may lessen. Stiffness may mean that the affected limb won’t ever move as it used to.

Many people with Complex Regional Pain Syndrome feel they are losing their mind as their short term memory evaporates and they lose their ability to concentrate on anything. However, they should try their utmost to take their medicines on time, exercise and get the required therapy.

Source: Patch

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