CRPS: Treatment for a Commonly Misunderstood Pain Syndrome

Complex Regional Pain Syndrome is a condition that causes chronic and debilitating pain in a person’s arms, legs, hands, or feet. The pain usually originates after an injury to the limb or with surgery on that affected limb. The cause of CRPS isn’t clearly understood, but it’s believed to be caused by damage to, or malfunction of, the peripheral nervous systems. CRPS represents an abnormal response that is often much greater and more painful than the initial injury.

Diagnosis of CRPS can be tricky since there aren’t any diagnostic tests, such as an X-ray or MRI, that can confirm CRPS. Doctors base their diagnoses from a patient’s medical history and signs and symptoms that match those most commonly seen in CRPS. The most telling feature of CRPS is usually a history of earlier injury to the affected area.

The key symptom of CRPS is prolonged pain that may be constant and can be extremely uncomfortable and severe. The pain may feel like a burning or “pins and needles” sensation, or as if someone is squeezing the affected area. In some patients, the pain may spread to include an entire arm or leg. Pain can sometimes even travel to the opposite arm or leg. Patients also experience increased sensitivity in the affected area, constant or random changes in temperature, skin color, and swelling of the affected limb, and differences in temperature as compared to the opposite limb. Additionally, the skin on the affected limb may also change color, becoming blotchy, blue, purple, pale, or red.

Treatment for CRPS is most effective when it is initiated early. Early detection and treatment can help improve symptoms and give patients a better chance at recovery from this condition. There are several ways the doctors at Pacific Pain Physicians treat patients with CRPS, including rehabilitation therapy, biofeedback, medications, sympathetic nerve blocks, or spinal cord stimulation.

Physicians usually begin with the non-interventional treatment spectrum when treating a patient with CRPS. An exercise program through rehabilitation therapy can keep the painful limb or body part moving and can improve blood flow, lessen the circulatory symptoms, help improve the affected limb’s flexibility, strength, and function, and help to prevent or reverse the secondary brain changes that are associated with chronic pain. Occupational therapy can help the individual learn new ways to work and perform daily tasks. Biofeedback is a treatment that teaches a patient to become aware of processes that are normally thought to be involuntary inside of the body (such as blood pressure, temperature, and heart rate control). This method enables the patient to gain some conscious control of these processes, which can influence and improve their level of pain. Several different classes of medication have been shown to be effective for CRPS, particularly when used early in the course of the disease. Drugs to treat CRPS include can include non-steroidal anti-inflammatory drugs, Neuropathic medications, opioids (in early stages), N-methyl-D-aspartate receptor antagonists, and topical local anesthetic creams and patches. A combination of these may be most effective.

When a patient with CRPS does not respond to conservative treatment, a physician will often move forward with interventional treatments. A sympathetic nerve block targets the sympathetic nervous system, a series of nerves that spread out from your spine to your body to help control several involuntary body functions. Sympathetic nerve blocks can be used to diagnose or treat pain involving the nerves of the sympathetic nervous system. These blocks are typically performed in a series. Physicians can also try spinal cord stimulation- a surgically implanted electrical device which decreases the perception of pain by targeting the spinal cord and brain pain processing centers. Before the surgical implantation, a one week minimally invasive trial is performed to see if there is significant pain relief which indicates that the device will help long-term.

CRPS perplexes many physicians, but the team at Pacific Pain Physicians has been diagnosing and treating this condition successfully for many of their patients. Living with CRPS can be very frustrating, and the team of doctors at Pacific Pain Physicians is here to help anyone with this condition alleviate their symptoms and get on a path leading them toward rehabilitation and recovery.