Complex Regional Pain Syndrome (CRPS)

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Complex Regional Pain Syndrome (CRPS)

Overview

Complex Regional Pain Syndrome (CRPS), formerly known as Reflex Sympathetic Dystrophy (RSD), is a chronic neuro-inflammatory disorder. 

It is classified as a rare disorder by the United States Food and Drug Administration. However, up to 200,000 individuals experience this condition in the United States, alone, in any given year.

CRPS is a form of chronic pain that usually affects an arm or a leg.  The reality is - CRPS can occur anywhere in the body.  CRPS generally follows a musculoskeletal injury, a nerve injury, surgery or immobilization, but it can also follow a sprain or strain.  The pain is out of proportion to the severity of the initial injury.

CRPS is uncommon, and its cause isn't clearly understood. Treatment is most effective when started early. Yet, it can take some patients years to get a diagnosis.  

CRPS occurs when the nervous system and the immune system malfunction as they respond to tissue damage from trauma. The nerves misfire, sending constant pain signals to the brain.   Essentially, think of it as the perfect storm in the brain.

The level of pain is measured as one of the most severe on the McGill University Pain Scale.  Most patients describe it as a burning, stabbing, gnawing pain.

The symptoms of CRPS can greatly impact the function of your affected limb or area, sleep, daily activities and overall mental health.

The persistent pain and disability associated with CRPS require coordinated / patient-centered care to achieve pain reduction and better function.  

While there is no cure at this time - it is possible to gain long-term remission. 

 Symptoms of CRPS

The symptoms include:

• Sensation of burning and stinging
• Sensitivity to heat or cold
• Swelling
• Changes in skin temperature — sweaty or cold at times
• Changes in skin texture, which may become tender, thin or shiny in the affected area
• Hair and nail changes
• Joint stiffness
• Continuous and throbbing pain
• Tremors and muscle spasms
• Atrophy of muscles
• Osteoporosis
• Reduced mobility of the affected area

Causes of CRPS

The cause of CRPS isn't completely understood.  At this time there simply is not enough research or statistical information to disseminate for us to truly understand the cause of CRPS, or why one person gets CRPS and another person with the exact injury is fine. 

CRPS is thought to be caused by an injury to or difference in the peripheral and central nervous systems.  

CRPS occurs when the nervous system and the immune system malfunction as they respond to an injury, strain, sprain, or incident.   The nerves misfire, sending constant pain signals to the brain, and the brain relays the wrong signal.   Essentially, think of it as the perfect storm in the brain.  [Think of it as malware in the brain.]

CRPS occurs in two types, with similar signs and symptoms, but different causes:

Type 1 - Also known as reflex sympathetic dystrophy (RSD), this type occurs after an illness or injury that didn't directly damage the nerves in the affected limb. About 90% of people with CRPS have type 1.

Type 2 - Once referred to as causalgia, this type has symptoms similar to those of type 1 but type 2 CRPS occurs after a distinct nerve injury.

Many cases of CRPS occur after a forceful trauma to an arm or a leg. This can include a crushing injury or a fracture.

Other major and minor traumas — such as surgery, heart attacks, infections and even sprained ankles — also can lead to CRPS.

It's not well understood why these injuries can trigger CRPS.  Not everyone who has such an injury will go on to develop CRPS. It might be due to an interaction between your central and peripheral nervous systems that isn't typical and different inflammatory responses.