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Do you have CRPS?

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03 Nov
Do you have CRPS?
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Do you have CRPS?

What is CRPS?

Chronic Regional Pain Syndrome is a neurological condition that causes increased pain. There are two types of CRPS, and the most common injury associated with developing CRPS is a bone fracture, especially a wrist fracture.
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CRPS usually affects an extremity (65%), with the upper extremity being more affected compared to the lower extremity; however, any part of the body can be involved. CRPS may spread to other extremities over time.
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Risk factors are female gender, fibromyalgia, rheumatoid arthritis, neuropathic inflammation, autonomic nervous system alterations, and psychological factors.
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Early diagnosis and initiation of treatment are critical to limit disease progression and improve patients’ quality of life.
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What are the types of CRPS?

Type I: This type occurs without nerve damage. It happens after an illness or injury that didn’t directly damage a nerve. Type I was formerly known as reflex sympathetic dystrophy.
Type II: This type occurs after known nerve damage. It was formerly known as causalgia.
CRPS can also be acute or chronic (lasting longer than 6 months)

What are Symptoms of CRPS?

Symptoms of CRPS typically start within four to six weeks after an injury, fracture, or surgery, but they can develop without a known cause.
Sensory changes are also common in the affected area and may include:

Increased sensitivity to painful stimuli (a pinch may feel more painful than usual).
Feeling pain from stimuli that are usually not painful (such as just touching your skin).
Numbness.

Other symptoms of CRPS in the affected area include:

Skin swelling: Swelling may come and go or remain constant.

Decreased function in your affected limb: You may experience a decreased ability to move your affected limb and/or increased stiffness. You may also have difficulty placing pressure on your affected limb or joint.
Skin temperature changes: The skin on your extremity may feel warmer or cooler compared to the opposite one.
Skin color changes: Your skin may appear blotchy, pale, purple/bruised, or red.
Skin texture changes: Your skin may become shiny and thin or excessively sweaty.
Changes in nail and hair growth: You may have rapid hair or nail growth or no growth.

Since the symptoms of CRPS usually improve over time, it’s easiest for healthcare providers to diagnose it in the early stages. It’s important to see a provider soon after you experience symptoms of CRPS.

How is CRPS diagnosed?

There’s no specific test to diagnose CRPS. Healthcare providers mainly diagnose it through a careful medical history, physical examination, and review of your symptoms. Your provider will ask you if you’ve had a recent injury or surgery.
They will look for:

A change in the appearance, temperature, and texture of your skin in the affected area.
A higher-than-expected amount of pain from an injury.
Any other diseases or conditions that could cause your pain, changes in your skin, or other symptoms.

They may order imaging tests, such as an ultrasound or magnetic resonance imaging (MRI), to look for underlying nerve damage. But it’s not always possible to find the nerve damage.
Your provider may also order other tests to rule out conditions that cause similar symptoms. For example, electromyography (EMG) may reveal other causes of neuropathy. A nerve block can also be used to help hone in on the pain source and help the provider determine if it is truly CRPS.

What is the treatment for CRPS?

CRPS recurs (happens again) in about 10% to 30% of people. Most recurrences are due to unknown reasons.
The most important goals are to relieve pain and restore movement and strength in the affected limb. By achieving pain relief, you increase the odds of improving its function and your quality of life. Carefully selected treatment plans allow some people with CRPS to successfully manage their pain and lead active lives.

Medications
Steroids or other anti-inflammatory drugs: Can help lower inflammation early on.
Bisphosphonates: Medicines that may reduce inflammation and help heal bones.
Anti-neuropathic drugs: Medications used for the treatment of nerve-related pain, such as gabapentin or nortriptyline, can help decrease pain signals.
Medications that lower the sympathetic nervous system response
Ketamine: Sometimes given through IV or cream to “reset” pain signals. About one-third of patients feel lasting relief.

Procedures and Surgery
Sympathetic Nerve Blocks: Injections that calm the nerves (fight-or-flight system) that contribute to pain.
Nerve blocks: Nerve blocks involve injection of local anesthetic “numbing” medications that last 6-8 hours and can help diagnose a nerve issue contributing to CRPS.
Peripheral nerve stimulators or nerve surgery: Peripheral nerve stimulators (PNS) can be implanted to “override” signals from overactive nerves. In some cases, if a trapped nerve is causing pain, it can be surgically released.
Spinal Cord Stimulation: A device placed near the spine sends electrical signals to lower pain.

Movement and Therapy

Physical and Occupational Therapy: Moving the limb helps prevent CRPS from getting worse. The use of mirror therapy and graded motor imagery can help regain functional use of the CRPS limb.

Hand Therapy: Important for people with pain in their hands or arms.

Emotional Support

Pain Psychology: Mindfulness and stress-management techniques can help calm the nervous system and reduce pain flare-ups.

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