Complex regional pain syndrome (CRPS)

Complex regional pain syndrome (CRPS) is a chronic pain condition usually affecting the arms or legs. It may develop after an injury, surgery, stroke or heart incident, with pain symptoms typically disproportionate to the severity of the original injury. 

A man at his desk holding his back in pain

There are two kinds of CRPS:

  • Type 1: Also known as reflex sympathetic dystrophy syndrome, this occurs after an illness or injury that did not directly damage the nerves in the affected limb and accounts for 90% of CRPS cases.
  • Type 2: Known formally as causalgia, this type of CRPS follows from nerve damage.

While the causes of CRPS are not always clear, the condition can arise after a traumatic physical incident, such as a fracture, amputation, crush injury, surgery, heart attack or infection. 

Experts believe CRPS may be due to a dysfunctional interaction between the central nervous system and peripheral nervous systems, creating an inflammatory response.

What are its symptoms?

CRPS symptoms include the following:

  • Sensitivity to cold or touch in the affected area
  • Burning and throbbing pain that is continuous
  • Swelling
  • Changes in temperature of the skin
  • Changes to colour of the skin – from white, blotchy, red or blue
  • Changes to texture of the skin, which may be tender to the touch, thin or even shiny in the affected area
  • Stiffness and/or swelling in the joints
  • Decreased mobility in the affected area
  • Muscle weakness

CRPS may occasionally spread from its source to another part of the body, for example, the opposite limb. The condition is exacerbated by emotional stress. 

How is it diagnosed? 

CRPS diagnosis can be tricky, especially in the early stages of the condition. While there are no specific diagnostic tests, certain tools can be used to rule out other conditions, for example, scans that can identify changes to bone and blood circulation. Stimulus tests to determine the source of pain may also be performed. 

Diagnosis is, however, aided by examining the following information and symptoms:

  • The original injury or incident
  • The severity of the pain (normally high) in relation to the injury
  • The appearance of the affected area

What are your treatment options? 

There is no cure for the condition. CRPS treatment varies based on symptoms, and a combination of treatments may be necessary. The condition may go into remission if treatment is started within a few months of the first symptoms. These treatment options may include:

  • Pain relievers: Over-the-counter (OTC) drugs such as aspirin and ibuprofen may ease pain and inflammation or stronger pain relievers may be prescribed if these are not effective, such as certain opioids.
  • Anti-depressants and anticonvulsants: These may be prescribed to treat pain from damaged nerves.
  • Steroid medication: Corticosteroids can reduce inflammation and improve movement in the affected limb.

In addition, cold or hot compresses, applying topical analgesics, physiotherapy, biofeedback and electrical nerve stimulation may also assist with pain relief. 

Can it be prevented? 

There is research to suggest that getting out of bed and moving around as soon as possible after a stroke lowers the risk of developing CRPS.

IMAGE CREDIT: 123rf.com

The accuracy of this information was checked and approved by physician Dr Thomas Blake in June 2016