Complex regional pain syndrome (CRPS) is an uncommon cause
of chronic pain. It may affect either
the lower extremities or upper extremities, and is a difficult medical problem
to diagnose and manage. CRPS is
characterized by intense pain out of proportion, which is commonly described as
a burning sensation. It can often
masquerade as peripheral neuropathy or tarsal tunnel syndrome in the foot, or
as carpal tunnel syndrome in the hand.
Complex regional pain syndrome is a dysfunction of the
autonomic nervous system. It can often
be divided into CRPS types I and II.
CRPS I is also referred to as reflex sympathetic dystrophy, and occurs
when there is injury without direct trauma to a specific nerve. CRPS II involves an injury including a
specific nerve, which develops into complex regional pain syndrome. The symptoms and progression of CRPS is the
same in both types.
The symptoms of CRPS evolve in stages. Stage one is the acute stage, where the onset
of intense pain out of proportion is seen.
This may develop some time after an injury. Temperature changes may be seen in the
earlier stages, as well as muscle pain in the area. In the second stage, the pain will worsen
with associated muscle atrophy and weakness of the affected extremity. The toenails or fingernails may show changes
in growth, and there may be noticeable hair loss on the extremity as well. The skin may begin to thin and become shiny,
with associated color changes. In the
third and final stage of CRPS, there is prolonged and often permanent pain,
with associated contracture of the limb.
By the time the disease progresses to stage three, x-rays of the
affected limb may show atrophy of the bone.
Because of the rapid progression of complex regional pain
syndrome, treatment of the condition depends on accurate and quick
diagnosis. Recent literature has pointed
at triphasic bone scans as being the test of choice when a diagnosis of CRPS is
possible. However, even the bone scans
fail to show changes consistent with CRPS all of the time.
Specialists in pain management typically carry out treatment
for complex regional pain syndrome.
Medications for pain relief as well as anti-depressants and
anti-convulsants are often used.
Steroids may be used to help reduce inflammation in the affected
limb. Changes in bone density may be
treated with drugs used for osteoporosis.
Injections with local anesthesia may be used to block the sympathetic
nerve fibers of the autonomic nervous system.
Other therapies include the use of topical analgesics,
alternating application of heat and cold, physical therapy-assisted exercise,
transcutaneous electrical nerve stimulation (TENS), and spinal cord
stimulation. Attempted sympathectomy has
been tried, with mixed results.
Though it is an uncommon disease, complex regional pain
syndrome can be extremely debilitating.
Thus, early detection and treatment is the key to success once CRPS is
diagnosed.
Central Florida Foot & Ankle Center, LLC
101 6th Street N.W.
Winter Haven, FL 33881
863-299-4551
www.FLFootandAnkle.com
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