CRPS, also known as chronic regional pain syndrome, is a condition thought to be due to an abnormality in the nerves in the spinal cord or limbs. Other terms used to describe this condition include reflex sympathetic dystrophy or causalgia.
CRPS symptoms
Generally, CRPS affects one of the extremities – hand, arm, leg, or foot. Usually, it’s intense burning and continuous pain out of proportion to the injury. Other symptoms include:
- Sensitivity of skin
- skin colour changes
- Skin temperature changes
- nail changes
- swelling, stiffness, and restricted movement of joints
Often, there is a history of trauma – either innocuous, such as a sprained ankle, or more severe, such as complex trauma after a fall or motor vehicle accident.
Sometimes, pain can spread to a broader area and sometimes to the other limbs.
Usually, emotion, anxiety, or depression can make the pain worse.
What causes chronic regional pain syndrome?
We are not entirely sure why CRPS occurs.
Recent studies suggest that the sympathetic nervous system nerves stop working correctly and fire with increased frequency. Another theory is that an injury leads to typical inflammatory changes. However, the healing process is disrupted, leading to specific symptoms of pain and swelling.
How is CRPS diagnosed?
Generally, it is often challenging to diagnose CRPS as symptoms overlap many other conditions. For example, a pinched nerve in an arm or leg can lead to similar symptoms.
Usually, tests such as X-rays, MRIs, and nerve studies rule out other conditions.
CRPS treatment
Generally, the earlier treatment is started, the better the outcomes. Often, a combination of treatments works best:
CRPS physical therapy
Overall, exercise therapy is thought to improve the movement and function of the affected legs. Often, an exercise that does not stimulate high pain levels is better to dampen the pain response.
Usually, counseling or psychotherapy to treat emotional or mental health issues of anxiety and depression will help.
New treatments for CRPS
Often, topical medications such as capsaicin cream can help confuse nerves and reduce nerve sensitivity.
In addition, medication tablets such as amitriptyline or duloxetine are good at reducing nerve sensitivity. However, other anti-depressants and strong painkillers, such as opioids, are less effective.
We think sympathetic nerve blocks, spinal cord stimulators, or surgery can help in more severe cases.
Commonly asked questions for chronic regional pain syndrome
Is CRPS genetic?
We are not sure. However, some evidence suggests that a family history makes you more susceptible to developing this condition after injury.
Is CRPS an autoimmune disease?
Overall, we think the immune system is essential to pain hypersensitivity. However, the characteristic findings of elevated antibodies in a typical blood screen are not a feature of CRPS.
Can you work with CRPS?
It depends on the severity of the symptoms. We always encourage people to work unless symptoms are too severe.
Final word from Sportdoctorlondon about chronic regional pain syndrome
It is vital to get an early diagnosis of CRPS. Early treatment will improve outcomes and an earlier return to full function.
“However, the usual findings of elevated antibodies in autoimmune disease is not a feature of CRPS.”
I think there is at least some evidence for autoantibodies in CRPS.
Dubuis, E, Thompson, V, Leite, MI, Blaes, F, Maihofner, C, Greensmith, D, Vincent, A, Shenker, N, Kuttikat, A, Leuwer, M, Goebel, A. Longstanding complex regional pain syndrome is associated with activating autoantibodies against alpha-1a adrenoceptors. Pain 2014; 155: 2408–2417.
Kohr, D, Singh, P, Tschernatsch, M, Kaps, M, Pouokam, E, Diener, M, Kummer, W, Birklein, F, Vincent, A, Goebel, A, Wallukat, G, Blaes, F. Autoimmunity against the beta2 adrenergic receptor and muscarinic-2 receptor in complex regional pain syndrome. Pain 2011; 152: 2690–2700.
Many thanks for your comment.
I have no doubt that CRPS is an autoimmune process. However, my comment pertains to the findings on a typical autoimmune blood screen. generally, in CRPS, the blood screen is negative – excluding a common immune-related condition such as lupus or inflammatory arthritis. I have clarified this statement in my blog.
Lorenzo
Very interesting. I think mine was caused by the cast being to tight. I don’t know why they don’t give you an information sheet telling you all the things ghst can go wrong with the cast so you know when to get help. Thus wd be an excellent idea. A fact sheet wd be great. For myself, I am in tge 20 percent that fell onto the wrist with the top of the hand down. I had a box in my hand when I fell. Twice I went to emergency to get the cast loosened. Terrible experience