Introduction
The Complex Regional Pain Syndrome (CRPS) is defined as a chronic condition characterized by a severe pain following injury to the bone and soft tissue.
The key characteristic of CRPS is the continuous intense pain, out of proportion to the severity of the injury. CRPS most often affects one of the arms, legs, hands or feet.
Often the pain associated to CPRS has been seen spreading to the entire arm or leg, even though the initiating injury might have been only to a finger or toe. Sometimes, pain even travels to the opposite extremity.
CRPS can occur at any age, but a greater incidence has been seen in the age group of 40 and 60, especially amongst women.
Types of CRPS
CRPS generally occurs in two types, having similar symptoms but different causes. These include:
Type I: Earlier known as reflex sympathetic dystrophy syndrome (RSD), this type occurs after an illness or injury that did not damage the nerves in the affected limb directly.
Type II: Once referred to as causalgia, this type of CRPS follows a distinct nerve injury.
Stages of CPRS
Experts believe that there are three stages associated with CRPS, marked by progressive changes in skin, muscles, joints, ligaments and bones of the affected area.
Here we briefly explain what each stage entails:
Stage I – It is believed that this stage lasts from one to 3 months and is characterized by severe, burning pain, muscle spasms, joint stiffness, rapid hair growth and alterations in blood vessels leading to change in skin color and temperature.
Stage II – This stage lasts for 3 to 6 months. The stage is typically characterized by intensifying pain, swelling, decreased hair growth, cracked, brittle, grooved or spotty nails, softened bones, stiff joints and weak muscle tone.
Stage III – By now, the syndrome progresses to the point where the changes in skin and bones become irreversible. Pain involves the entire limb and there may be a marked muscle loss, severely limited mobility and involuntary contractions of the muscles and tendons.
CRPS – Signs and Symptoms
The intense ‘burning’ pain is the main symptom of CRPS. Here we list some of the additional symptoms of CRPS:
· Skin sensitivity
· Increased sweating
· Changes in skin temperature
· Changes in hair and nail growth
· Joint stiffness, swelling and damage
· Muscle spasms, weakness and loss
· Motor disability
Diagnosis and Treatment
Various diagnostic tools employed to detect the presence of CRPS include thermography, sweat testing, x-rays, electrodiagnostics and sympathetic blocks.
The treatment modalities for CRPS centre on relieving painful symptoms, as no generic cure is known for the disease. Treatment plan is aimed at helping the patients get on with their normal lives. The main therapies include:
· Physical therapy
· Psychotherapy
· Sympathetic nerve block
· Medications
· Surgical sympathectomy
· Spinal cord stimulation
· Intrathecal drug pumps
· Acupuncture
· Transcutaneous Electrical Nerve Stimulation (TENS)
· Desensitization
