Chronic Regional Pain Syndrome (CRPS), also known as Causalgia and Reflex Sympathetic Dystrophy, is a chronic pain condition unlike any other. The cause is unknown, there is no way to test for it, there is no cure and it can get worse over time. Typically, CRPS causes intense pain in the arms, hands, legs or feet. Usually developing after an injury, surgery, stroke or heart attack, this condition is characterized by pain that is far more intense than would be warranted by the initial injury.
Although there is no particular cure, there is hope through treatment to alleviate some of the symptoms of the disorder itself. CRPS can often be a frightening experience for individuals because so much about it remains a mystery. However, with the right amount of medical attention and a persistent attitude focused on recovery, many individuals are able to lessen their pain and lead happy, fulfilling lives with CRPS.
The Anatomy and Types of CRPS
Research is delving further and further into CRPS, attempting to isolate the anatomy of the disorder and its possible etiology. It is believed by many that this condition is a result of neurogenic inflammation, and other bodily responses, due to a disproportionate response to tissue injury. As such, CRPS is typically associated with the dysfunction of both the Central Nervous System (CNS) and the Peripheral, or Autonomic, Nervous System (PNS).
There are two major types of the disorder that individuals may experience. The first, or Type I, is formerly known as Reflex Sympathetic Dystrophy (RSD). In this more common type, there are no indications of nerve lesions on the body, although the spreading of the ailment throughout the body is common. In contrast, Type II, formerly known as Causalgia, has demonstrable signs of nerve damage. This type is more painful for individuals with CRPS and is more unlikely than Type I CRPS to spread throughout other areas of the body. However, it is possible for someone with Type II of this condition to develop distinct areas of Type II CRPS in other areas of the body, in addition to the original area of pain.
Possible Causes of CRPS
The different causes of CRPS are another area of the condition that is simply not well understood. The biggest medical mystery still being researched is why some people develop the condition in response to the same injuries or ailments that provoke no such response in others with similar situations.
In almost all of the cases of CRPS, the condition is onset by a clear history of trauma or injury including sprains or strains, soft tissue injury, such as cuts or bruises and surgical or medical procedures. Additionally, many nerve abnormalities can often be found in those who do develop the disorder. Peripheral nerve irregularities can often trigger anomalies in terms of the neurological function of the Central Nervous System (CNS). This can lead to more complex forms of CRPS, further complicating treatment options and the condition itself.
Another abnormality in those with CRPS is certain irregularities in the immune system. Cytokines are a common inflammatory chemical that is secreted in excessive amounts in people with CRPS. This exacerbates the pain being experienced and is indicated by redness, swelling and warmth.This cause can quickly escalate to a cyclical nature, effectively worsening the pain and symptoms being experienced. Irregular blood vessels also worsen this aspect of the condition, leading to further swelling of the muscles and underlying tissue that often results in muscle and joint pain or damage.
Doctors may also want to consider genetics or other factors in evaluating the cause of the condition. Some data suggests a possible genetic link in cases of CRPS, although this is all speculative. Additionally, some internal injuries can cause the onset of the ailment, leaving no traceable signs of damage where damage actually exists.
Common Signs and Symptoms of CRPS
Complex regional pain syndrome has any number of associated symptoms that are also typical of some other chronic pain disorders. However, it is the severity of the symptoms themselves that suggests that CRPS is the culprit for the pain.
Common symptoms of CRPS include many variations of pain including burning or throbbing in the affected areas, swelling of the painful area, sensitivity to touch or temperature, joint stiffness and swelling and decreased ability to move the affected body parts. Aside from the sensational signs of CRPS, other symptoms that can be identified include changes in skin temperature, changes in skin color, changes in skin texture and changes in hair and nail growth,
For a proper diagnosis, it is not necessary for all of these symptoms to be present. This is especially true in consideration of the fact that the symptoms commonly change over time. Most frequently, individuals with CRPS will first experience the pain, swelling and redness associated with the disorder. As the condition progresses, however, the physical changes to the skin will begin to occur. Although the frequency and the severity of the condition varies, and can actually resolve itself on its own for some people, medical attention is most effective early on in the illness.
So, How is CRPS Diagnosed?
Although there is no diagnostic test for CRPS, there are many different methods that physicians use to narrow down the possible reasons for the onset of the condition.
Bone scans are often used during diagnosis to detect any changes in bone structure or internal injuries that may exist. Because CRPS is often caused by injury, which can be either external or internal, this is an integral component of the diagnosis process to ensure that internal injury is, or isn’t, the answer to an individual’s pain and problems.
Another common test used to better determine the cause of the condition isa sympathetic nervous system test. This particular test seeks to find disturbances in the Sympathetic Nervous System which can measure bodily functions like skin temperature and blood flow. Differences throughout different parts of the body can often indicate Complex Regional Pain Syndrome, especially when comparing the arms or the legs against each other.
Other options at the hands of physicians include imaging such as x-rays or MRIs. Nutritional deficiencies that can lead to internal injury are made obvious through x-ray imaging. Additionally, tissue changes are visible by conducting MRI scans. This allows a doctor to perceive everything that is occurring in a person’s body, helping to narrow down what disease, or condition, might be causing an individual’s chronic pain.
Medication and Therapy: A Winning Treatment Duo
As is the case for many chronic pain conditions, CRPS is best treated through a combination of medications and therapies.
Medications that are commonly used to treat this condition include pain relievers, antidepressents and anticonvulsants, corticosteroids, bone-loss medications and sympathetic nerve-blocking medications. Pain relievers and sympathetic nerve-blocking medication both work to block the pain of the affected nerves through either over-the-counter treatments or prescribed substances. Antidepressants and anticonvulsants are also used in combination with pain relievers to ease the pain of the affected nerves. Bone-loss medications are also common for those with internal damage or bone loss that may be source of their chronic pain.
In addition to medications, many people seek therapeutic relief from their symptoms. Applying heat and cold in accordance with each affected area is a good way to relieve pain when at home. Along with this routine, applying topical analgesics such as lidocaine is a great way to achieve further direct relief to an affected area. Physical therapy can also be a great solution for those with major limbs being affected by CRPS.
Gentle, guided exercise of the affected areas can greatly improve the range of motion and strength that is frequently compromised by this condition. Biofeedback is another great option to help individuals with CRPS become more aware of their body and its processes. Although it is not easy to manage this pain, remaining cognizant of what the body is going through is a great way to both recognize and reduce the pain being experienced.
Electrical current is often recognized as another effective way through which to manage the chronic pain caused by CRPS. By participating in either Transcutaneous Electrical Nerve Stimulation (TENS) or spinal cord stimulation, an individual is often granted relief from the constant pain of CRPS, bettering their ability to proceed with other treatments that lessen the pain of the condition for longer periods of time.
Prognosis
Complex Regional Pain Syndrome is unique in that it is one of the only chronic pain conditions that can consistently spread throughout the body without well-known treatments as options. However, this is not to say that recovery is impossible. When detected early, CRPS is treatable through medication and therapy. While the chronic pain of the condition may never entirely subside, a variety of mental and physical treatments can help grant those with the ailment a normal, fulfilling life. For this reason, there is always hope for those with CRPS for a brighter, better future.