What is Complex Regional Pain Syndrome Type 1?
Complex Regional Pain Syndrome (CRPS), formerly known as reflex sympathetic dystrophy (RSD), is a condition where a combination of dramatic symptoms occurs after trauma to a body part, usually the upper or lower limb. However, the intensity of symptoms seems to be disproportionately severe compared to the degree of trauma itself.
There are two types of this syndrome, which is also known as reflex sympathetic dystrophy. Type 1 is where there is tissue injury but without nerve involvement, while type 2 is where there is an associated nerve injury. Symptoms may be similar in both types of the disorder.
Young females are often affected, and the body parts usually involved are the arms, legs, hands or feet. The condition usually occurs after a traumatic injury like a fracture but may also be associated with infections, surgery, burns or malignancy. Those who suffer from migraine headaches are also more likely to be afflicted with CRPS than those who do not.
Symptoms of Complex Regional Pain Syndrome Type 1
CRPS I is a chronic pain condition characterized by:
- Intense, burning pain, which gets worse with exercise
- Increasing sensitivity to touch, which elicits pain
- Change in skin temperature, which may be warmer or cooler than the opposite extremity
- Skin color changes, which may appear reddish, bluish, purple or blotchy
- Changes in the pattern of growth of the nails and hair of the extremity involved
- Swelling and stiffness
- Abnormality in sweating pattern of the limb involved
- Motor disability may not be affected, although it is possible
There are three stages of CRPS I:
- Stage 1 – characterized by warmth of the skin accompanied by skin color changes, rapid hair growth, severe pain and spasm; lasts for one to three months
- Stage 2 – characterized by increasing pain, decreased hair growth, nail changes, weakened muscles, stiff joints; lasts for three to six months
- Stage 3 – characterized by having coldness of the skin, loss of muscle and pain involving the whole extremity; changes are irreversible
Diagnosis and Treatment of CRPS I
The diagnosis of CRPS I is difficult because there are no diagnostic tests that can conclusively point to its identification. History and physical examination are often incompatible since the degree of pain usually is far greater than the injury observed. Often, elimination of other possible causes for the physical changes provides a clue that the diagnosis is closer to a pain syndrome than to a disease entity. No specific laboratory test is indicated, although tests for skin temperature and sweating and imaging studies may be done to observe the changes in the extremity.
Acute treatment of pain and inflammation includes the use of oral and topical pain relievers, anticonvulsant drugs, antidepressants, corticosteroids, and opioids. These do not afford long-lasting relief, and other modes of treatment may be needed such as:
- Sympathetic nerve blocks – involves the use of anesthetics to directly block the sympathetic nerves near the spine
- Surgical sympathectomy - surgical ablation of sympathetic nerves; this is a controversial method in terms of its benefits
- Spinal cord stimulation – using electrodes, the spinal cord is stimulated to make the patient feel a pleasant tingling sensation in the painful area
- Injection of opioids and local anesthetic agents into the spinal canal for pain relief
- Psychotherapy – helps patients suffering from depression, anxiety, or post-traumatic stress disorder to cope with the condition which, likewise, affects their families
- Physical therapy – involves the use of gentle weight bearing and gliding exercises to increase mobility and strength
- Occupational Therapy – a home exercise program using active compression and distraction exercises, scrubbing, carrying and desensitization techniques
- Recreational therapy – by involving a patient in pleasurable activities, he/she is aided in decreasing depression and increasing socialization
- Vocational therapy – helps the patient return to normal work activities
More research is needed to improve the results of treatment for complex regional pain syndrome type 1. Some patients improve with little treatment while others progress to a disabling degree. Early diagnosis and treatment are helpful in avoiding complications like depression and deformities. Patient education is especially important so that he/she can benefit more from the rehabilitative therapy prescribed.
Singh, Manish K MD, “Complex Regional Pain Syndromes”, https://emedicine.medscape.com/article/328054-overview
NINDS, “Complex Regional Pain Syndrome Fact Sheet”, https://www.ninds.nih.gov/disorders/reflex_sympathetic_dystrophy/detail_reflex_sympathetic_dystrophy.htm