Complex Regional Pain Syndrome Pain Management in Knoxville, TNComplex Regional Pain Syndrome (CRPS) is a chronic pain syndrome that affects the arm or the leg. It was previously known as reflex sympathetic dystrophy or causalgia. CRPS causes increase pain and inflammation in the affected limb. It usually follows an injury, surgery, stroke, or heart attack. Women are more likely to develop CRPS than men and it usually occurs in people around the age of 40. Young children and the elderly do not tend to develop this syndrome.
CRPS Type 1 vs Type 2Complex regional pain syndrome is divided into two types, type 1, and type 2. CRPS type 1 occurs after an injury. With type 1, the nerve that is injured is not identified. CRPS type 2 comes after a specific nerve injury. The injured nerve is identified with type 2.
What Causes Complex Regional Pain Syndrome?CRPS is caused by an injury, illness, stroke, or heart attack. In some instances, the cause is unknown and in 10% of individuals, there is no known cause or injury. Fractures, sprains/strains, and limbs immobilizations can all restrict movement, blood flow, and cause prolonged disuse of the limb. This can cause pressure on the nerve and cause injury. Surgery, penetrative injuries (large or small), and burns/cuts can all cause CRPS by damaging underlying peripheral nerves. Patients with poor circulation and poor nerve health such as those with diabetes or peripheral vascular disease, are more at risk for developing CRPS. Those with poor circulation that have CRPS should keep the affected limb elevated as well as exercise daily and wear compression garments. Patients with other autoimmune conditions are at an increased risk of developing CRPS after an injury or illness.
StagesThere are three stages to this disease. The first is called Stage 1 (acute). This stage usually lasts 1-3 months. The patient can experience burning and increased sensitivity to the area. The pain is constant and long lasting and followed by swelling, warmth, and redness. The second stage is called Stage II (Dystrophic). This stage can last up to 1 year. Pain and stiffness increase in the area during this stage. Swelling is more constant, and the area becomes more sensitive. The final stage is called Stage III (Atrophic). This stage occurs after 1 year. Skin changes are present, and the limb is stiffer. Pain can decrease at this time but spread to other areas of the body. There is less hope of recovery at this stage.
SymptomsSymptoms of Complex Regional Pain Syndrome are similar between both type 1 and type 2. They include:
- Continuous, unprovoked pain in the arm or leg. Most patients describe this pain as burning or throbbing. It can also be described as pins and needles.
- Sensitivity to hot and cold
- Swelling to the affected limb
- Changes in skin color and temperature. The limb may go from white, blotchy, blue, red, or grey. The temperature of the skin can fluctuate from hot to cold.
- Changes in hair and skin growth. The affected limb may grow more hair and the nails may grow faster than other limbs.
- Joint stiffness
- Allodynia. Increased sensitivity to light touch.
- Hyperalgesia. Severe pain after a mild stimulus.
- Impaired muscle strength
- Muscle spasms
Complex Regional Pain Syndrome Type 1.CRPS type 1 was once known as reflex sympathetic dystrophy. As mentioned previously, it occurs after an injury that does not directly damage a nerve. This is the most common type as 90% of all patients are diagnosed with type 1.
Complex Regional Pain Syndrome Type 2.CRPS type 2 was once known as causalgia. This typically occurs after a specific nerve injury is identified. Patients with type 2 usually have the same symptoms as type 1 but the injury or the damage to the nerve is more extensive. Type 2 causes damage to both the peripheral and motor nerves.
DiagnosisEarly detection and diagnosis of CRPS will help recovery and treatment. Unfortunately, there is not one test that will confirm the presence of CRPS. Most patients start by having a detailed examination by their physician. If skin changes are present, it may help doctors determine the affected nerve. Imaging with an x-ray can help determine any bone loss. A bone scan can also help determine any changes to the underlying bone. An MRI can help determine any changes or damage to the underlying tissue and an EMG or nerve conduction study can be done. EMGs can detect some CRPS nerve injuries but not all. A sweat production test is another way to detect CRPS. If abnormal, it may indicate the presence of CRPS in that limb.
Treating Complex Regional Pain SyndromeTreatment for complex regional pain syndrome can be difficult and some cases can last for months or years. Mild cases usually recover on their own but in more severe cases, it can be permanent. Early diagnosis and treatment will help patients recover quicker. Medications can be used to help treat the pain. There is not one treatment or medication for CRPS. NSAIDs such as ibuprofen and naproxen are used to help treat pain and any underlying inflammation. Acetaminophen can be used as a pain reliever. Most patients will need medication to help specifically with nerve pain. Medications such as Nortiptyline, Amitryptiline, Gabapentin, and Lyrica can be prescribed to help with the nerve pain. Opioid medications can be used to help with the pain but run the risk of dependence and must be carefully prescribed and monitored. Fosamax or other medications taken to reduce bone loss can be used to help limit the amount of bone damage and corticosteroids can be taken either orally or injected into the affected limb. Physical and occupational therapy is always to be a treatment option. It is good for the patient to stay active and for the affected limb to maintain strength and flexibility. It also improves blood flow to the area. Mirror therapy can also help trick the pain to reduce pain. Depending on the diagnosis, Knoxville Complex Regional Pain Syndrome specialists will choose the most effective treatment to provide immediate pain relief.
Coping with CRPSComplex regional pain syndrome can be a long debilitating condition. It can last for a few months to a few years and the pain can relentless. Many patients struggle to cope with the pain and find it difficult to find support from family and friends. Unfortunately, many people don’t believe the amount of pain that this condition can cause. CRPS is known to affect mental health. Maintaining a daily routine, getting enough sleep, socializing, and doing activities/hobbies area all ways patients can help maintain good mental health. It is important to find support with mental health with a chronic medication condition, especially one that causes such chronic pain. Patients with CRPS can develop depression, anxiety, and post-traumatic stress disorder. Finding a support group, counselor, psychologist, or therapist may be needed to help deal with some of the emotions associated with this condition. Mental health treatment and support is just as important as any other medical treatment.
Treatment for Complex Regional Pain Syndrome in Knoxville, TNAn action pain management plan is your number one priority because if you address the pain you can deal with the issue! Omega Pain Management, is one of the best pain clinics in Knoxville, TN and is under the leadership of pain management specialist Dr. Igor Smelyansky. He is one of the best Complex Regional Pain Syndrome Knoxville specialists. And even though the exact causes of RSP are foggy, if you are diagnosed with the condition it’s critically important to get your pain under control. Call 865-337-5137 today and take action!
Complex Regional Pain Syndrome. www.mayoclinic.org/diseases-conditions/crps-complex-regional-pain-syndrome/diagnosis-treatment/drc-20371156?p=1 (2022)