Reflex Sympathetic Dystrophy/Complex Regional Pain Syndrome - What is it?

What is Complex Regional Pain Syndrome/Reflex Sympathetic Dystrophy?

Reflex Sympathetic Dystrophy is an older term that has been replaced by Complex Regional Pain Syndrome.

Complex Regional Pain Syndrome (CRPS) is a chronic progressive pain disease that is linked to the dysfunction of the nervous system that distorts and amplifies pain messages. It is characterized by intense burning pain, swelling and changes in the skin and typically affects a distal limb such as an arm or a leg.

Who is at risk?

CRPS does not discriminate based on age, sex or race. It can strike at any age. However, the mean age at diagnosis is 42. CRPS has been even diagnosed in children as young as 2 years old. CRPS appears 3x as likely to affect women as compared to men.

CRPS Symptoms

Signs and symptoms of complex regional pain syndrome include:
-Continuous burning or throbbing pain, usually in your arm, leg, hand or foot
-Sensitivity to touch or cold
-Swelling of the painful area
-Changes in skin temperature — at times your skin may be sweaty; at other times it may be cold
-Changes in skin color, which can range from white and mottled to red or blue
-Changes in skin texture, which may become tender, thin or shiny in the affected area
-Changes in hair and nail growth
-Joint stiffness, swelling and damage
-Muscle spasms, weakness and loss (atrophy)
-Decreased ability to move the affected body part
In most cases, CRPS has 3 stages. However, CRPS does not always follow this pattern.

STAGE 1 (lasts 1 - 3 months):
-Changes in skin temperature, switching between warm or cold
-Faster growth of nails and hair
-Muscle spasms and joint pain
-Severe burning, aching pain that worsens with the slightest touch or breeze
-Skin that slowly becomes blotchy, purple, pale, or red; thin and shiny; swollen; more sweaty

STAGE 2 (lasts 3 - 6 months):
-Continued changes in the skin
-Nails that are cracked and break more easily
-Pain that is becoming worse
-Slower hair growth
-Stiff joints and weak muscles

STAGE 3 (irreversible changes can be seen):
-Limited movement in limb because of tightened muscles and tendons (contracture)
-Muscle wasting
-Pain in the entire limb

What are CRPS Treatments?

There is no cure for CRPS, but the disease can be slowed. The main focus is on relieving the symptoms and helping people with this syndrome live as normal a life as possible.

Most common therapies used:
PHYSICAL THERAPY: Physical therapy should be started as early as possible. A gradually increasing exercise program to keep the painful limb or body part moving may help restore some range of motion and function.

SYMPATHETIC NERVE BLOCK: Some patients will get significant pain relief from sympathetic nerve blocks. Sympathetic blocks can be done in a variety of ways. One technique involves intravenous administration of phentolamine, a drug that blocks sympathetic receptors. Another technique involves placement of an anesthetic next to the spine to directly block the sympathetic nerves.

MEDICATIONS: Many different classes of medication are used to treat CRPS, including topical analgesic drugs that act locally on painful nerves, skin, and muscles; antiseizure drugs; antidepressants, corticosteroids, and opioids. However, no single drug or combination of drugs has produced consistent long-lasting improvement in symptoms.

SURGICAL SYMPATHECTOMY: The use of surgical sympathectomy, a technique that destroys the nerves involved in CRPS, is controversial. Some experts think it is unwarranted and makes CRPS worse; others report a favorable outcome. Sympathectomy should be used only in patients whose pain is dramatically relieved (although temporarily) by selective sympathetic blocks.

SPINAL CORD STIMULATION: The placement of stimulating electrodes next to the spinal cord provides a pleasant tingling sensation in the painful area. This technique appears to help many patients with their pain.

KETAMINE: An anesthesiologist administers this dissociative anesthetic that attempts to reset the neurotransmitters in the nervous system. There are two treatment techniques. The first technique consists of a low dose Ketamine infusion over several days. The second technique consists of putting the patient into a medically-induced coma and then administering an extremely high dose of ketamine.
AMPUTATION: This option is considered as a last resort.

What is the prognosis?

The prognosis for CRPS varies from person to person. Spontaneous remission from symptoms occurs in certain people. Others can have unremitting pain and crippling, irreversible changes in spite of treatment. Some doctors believe that early treatment is helpful in limiting the disorder, but this belief has not yet been supported by evidence from clinical studies. More research is needed to understand the causes of CRPS, how it progresses, and the role of early treatment.