Complex regional pain disorder, which is more commonly referred to as complex regional pain syndrome (CRPS), is a relatively rare chronic nerve disorder. Why some people end up with this disease is unclear, although it is triggered by an injury to either a nerve or tissue. It may be caused by sympathetic nervous system problems, a disoriented immune system, both or a number of unknown factors. It usually affects the arms, legs, hands or feet and causes serious pain as well as changes in the color and temperature of the skin of the affected region.
Although CRPS starts out troubling only the affected limb, it can spread to other areas of the body, becoming gradually worse as time goes by. On the other hand, especially when treatment starts as early as possible, CRPS can go away, sometimes permanently.
What is it like to have CRPS? With this disorder there is an intense, burning pain in the extremity that is affected which only gets worse over time. Skin sensitivity, swelling and stiffness of the affected joints, both increases and decreases in hair growth and a decreased ability to move the limb also occur. The skin of the limb or other area of the body goes through several changes:
- Temperature, either warmer or cooler
- Color, the skin will be blotchy, red or pale
- Texture, there may be a lot of sweating and the skin may become thin
The pain and other symptoms evolve over a period of months, starting with localized pain, joint stiffness, hair growth and skin changes due to how the blood vessels are reacting to the disorder. Hair growth slows, the nails may become brittle and cracked, the joints become stiff, the bones become soft and the muscles become weaker — and the pain increases. After several months the symptoms may be affecting an entire limb and changes to bone, joints and muscle are irreversible.
There is no cure for complex regional pain disorder and even for people who go through treatment symptoms may persist. Other people may have a very positive experience with the symptoms going into remission for a time, or for good. Treatment includes the use of several therapies to help reduce the pain and improve the health of the affected limb.
Physical therapy is used to try and retain movement of the limb and to slow muscle atrophy. Physical therapy is much more effective if started early on.
Medications are an important part of treatment for CRPS. It is likely that a combination of different drugs will be used to try and alleviate the symptoms as much as possible. Pain relievers, antidepressants, anti-seizure medications, corticosteroids and opioids may all be recommended. Sympathetic nerve-blocking medication may also be injected directly into the affected nerves to block pain fibers. Some drugs may be pumped directly into the spinal fluid. This allows for a smaller amount of the drug to have a more potent affect.
Spinal cord stimulation is another technique that may help with pain relief. Electrodes are inserted along the spinal cord. An electrical current then runs through the spinal cord, which creates a pleasant sensation in place of the pain.
Psychotherapy can play an important role in the treatment of CRPS especially if a patient is suffering from post-traumatic stress disorder or anxiety due to what happened when the injury occurred. Improving mental well-being can help to reduce the intensity of the physical symptoms.
Complex regional pain disorder can be an extremely powerful pain syndrome. There are a variety of treatment options which can be used to relieve the pain, and each individual will have a unique response to the disease and to treatment. There is hope however as for some people the symptoms of CRPS do go away.
National Institute of Neurological Disorders and Stroke, https://www.ninds.nih.gov/disorders/reflex_sympathetic_dystrophy/detail_reflex_sympathetic_dystrophy.htm