Complex regional pain syndrome (CRPS) is a debilitating chronic pain condition that typically affects upper or lower extremity, following trauma, injury, fracture, sometimes surgery or nerve injury or stroke. The pain can be excruciating and out of proportion to initial injury.
CRPS is not very uncommon and if treatment is not started early, then it may lead to persistent chronic pain with disability.
Symptoms and Signs
There is a specific diagnostic criterion for CRPS.
- Excessive pain in comparison to type of initial injury and no other cause found
- Pain can be burning or throbbing, usually in the arm, leg, hand or foot
- Sensitivity to touch or cold
- Swelling of the painful area
- Changes in skin temperature — alternating between sweaty and cold
- Changes in skin color, ranging from white and blotchy to red or blue
- Changes in skin texture, which may become tender, thin or shiny in the affected area
- Changes in hair and nail growth
- Joint stiffness, swelling and damage
- Muscle spasms, tremors and weakness
- Decreased ability to move the affected body part
All these or part of these can be present in patients with CRPS and they are classical of the disease. Diagnosis is usually based on clinical signs and symptoms and excluding other causes by lab or radiological tests.
CRPS is a complex condition to treat. Early and multidisciplinary treatment involving Pain Specialist, Physiotherapy, Occupational Therapy and other specialists can result in resolution of symptoms.
Treatment options include:
- Medication- ranging from anti-inflammatory, opioids, nerve pain medicine, antidepressants, corticosteroids, bisphosphonates, calcitonin, ketamine and topical creams
- Physical & Occupational Therapy- This forms the mainstay of the whole treatment including contrast bath, desensitization, edeme control, improvement of range of movement, muscle deconditioning and activation, isometric exercises and others.
- Interventional pain management- We perform sympathetic blocks like stellate, lumbar sympathetic chain (sympathetic nerves are a special group of nerve that innervate blood vessel, sweat glands or viscera and they get abnormality cross-linking with pain carrying sensory nerves in CRPS). These procedures are best done in OT under X-ray and ultrasound guidance as the nerve travel deep in the vicinity of spine.
- Ketamine infusion- intravenous injection in low dose helps good number of patients.
- Spinal cord stimulation- An electrical lead similar to pacemaker is inserted around the spinal cord and this is considered as a last resort with excellent result.