Learn More About CRPS
CRPS — Complex Regional Pain Syndrome
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Complex Regional Pain Syndrome (CRPS), previously known as Reflex Sympathetic Dystrophy (RSD), is a very rare and extremely painful chronic medical condition. Affecting only 0.0005% of people, CRPS is not fully understood by the medical community, making it increasingly frustrating for suffering patients. CRPS is usually caused by injury, illness, surgical procedure, or psychological stress; however, how these factors can lead to CRPS is not fully understood because the pain experienced with CRPS is out of proportion to the original injury or cause.
During an acute injury the brain will receive danger messages from the nerves in our body and respond to those messages by causing us to experience pain in the affected area. Our brain does this to protect us and to bring awareness to an injury that may require medical attention. Sending pain is the brain's protective response to let your body know something is wrong. Once we have the injury looked at by a medical professional and get the proper treatment the pain slowly begins to decrease. With CRPS the same process occurs, however unlike an acute issue like a broken bone, the pain never returns back to normal. Instead, the patient will experience constant pain due to the danger messages being sent from their nerves — essentially a malfunction of our nervous system. This influx of danger messegages result in a confused and overwhelmed brain that only knows how to respond by sending pain. This process repeats over and over until our nerves are retrained to understand the difference between a real injury and a “false alarm”.
CRPS, in particular, is known as the most painful condition in existence. It ranks the highest on the McGill Pain scale (a scale developed to measure the amount of pain someone can experience) with a 42/50. Some research indicates that in specific cases of CRPS the paitents pain can reach up to a 47/50 on the McGill pain scale. CRPS pain tops childbirth without medication, non terminal cancer, and even amputation without medication or anesthesia.
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Many symptoms of CRPS include…
Allodynia (extreme pain caused by a stimuli that typically would not cause any pain such as a light touch or breeze)
Headaches
Skin changes
Color changes
Temperature changes
Hair and nail growth changes
Swelling
Stiffness
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CRPS is very hard to diagnose as it doesn’t appear on scans such as X Rays or MRIs. While abnormalities such as bone loss can appear in certain scans, making the likelihood a patient has CRPS greater, many times scans will come back normal making CRPS exceedingly frustrating.
Typically CRPS is diagnosed after ruling out every other possible cause or condition. To be diagnosed, a patient must exhibit multiple symptoms listed on the Budapest Criteria (a list of symptoms often used to diagnose CRPS).
The Budapest Criteria includes…
Continuing pain that is disproportionate to the original injury or event
Reports of Hyperaesthesia and/or Allodynia
Reports of temperature or skin color changes
Reports of sweating changes
Reports of decreased range of motion and/or weakness, tremors, or dystonia
Reports of trophic changes (hair, nail, skin)
CRPS is diagnosed when a patient meets the Budapest Criteria and all other possible diagnoses have been ruled out.
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The best treatment for CRPS is Physical Therapy and movement, however this can be very difficult due to the amount of pain patients experience. Oftentimes doctors prescribe certain drugs to decrease pain so patients can have better outcomes in physical therapy. Some of these drugs may include… Gabapentin, Pregaba, and Amitriptyline. Many doctors also recommend slightly more invasive treatments if all other routes fail such as nerve blocks, spinal cord stimulators, or ketamine infusions.
Aside from physical therapy both cognitive behavior therapy (CBT) and desentization are essential in CRPS recovery. While the pain is very real and not “all in your head,” the nervous system plays a major role in the continuous pain patients experience. This neurological component makes it essential for patients to learn coping strategies to retrain their brain to not send pain when there is no threat present. Patients are able to do this through CBT.
Desentization is also necessary for patients who suffer from Allodynia, a condition that is typically common with CRPS. Allodynia causes extreme amounts of pain to stimuli that are not usually painful such as a light touch. Desentization, or exposing the effect area to different textures, is a promising way to reduce Allodynia.
For pediatric cases, CRPS is best treated with an intense rehabilitation program consisting of several hours of Physical therapy, occupational therapy, and psychological therapy.
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