CRPS Transcript

Opening: This audio segment on complex regional pain syndrome is brought to you by The Resource Center of the Department of Pain Medicine and Palliative Care at Beth Israel Medical Center in New York City, and is made possible through a generous grant from The Mayday Fund.

Complex Regional Pain Syndrome -- What You Should Know

Have you been told you have reflex sympathetic dystrophy or causalgia? If so, you have complex regional pain syndrome.

What Is Complex Regional Pain Syndrome?

It is a chronic pain condition that usually happens after an injury. There is pain, a change in blood flow, sweating and swelling. There can be changes in your skin, bones and other tissues. Sometimes it is hard to move the painful body part.

Complex regional pain syndrome usually involves your arms or legs. But it can affect any part of your body. It can be progressive. This means it can get worse at one place or spread to other body parts. It can also stay the same or get better on its own. The injury that leads to complex regional pain syndrome may be very minor. Some patients cannot remember any injury at all.

If the condition comes on after injury to your skin, bone, joint or tissue, it is called reflex sympathetic dystrophy or complex regional pain syndrome one. If the injury was to a major nerve, this is called causalgia, or complex regional pain syndrome 2.

Doctors used to think complex regional pain syndrome meant there was a problem with your sympathetic nervous system. These are the nerves that control the size of blood vessels, sweating and other bodily functions. Now they know that complex regional pain syndrome is actually caused by some other problem with the nervous system. Although some patients with this condition get better when sympathetic nerves are blocked, many do not.

Who Gets Complex Regional Pain Syndrome?

No one knows why some injuries cause complex regional pain syndrome. Experts say the chance of getting it may run in your family. Or you may have been under some kind of stress when you were injured. Or the injured body part was not being used for a long time; for example, if it was in a cast or a sling. But no one really knows.

What Are the Symptoms?

These are the symptoms doctors use to decide whether you have complex regional pain syndrome:

1) Pain that is constant or almost constant. It's often burning. There may be sensitivity of the skin, so that clothing, wind, cold or light touch worsen the pain.

2) Having some of the following in the painful area:

Swelling

Changes in your skin color

Skin temperature that is not normal, and

Either more or less sweating in the area

Other common symptoms include problems moving the painful body part, tremors, depression and anxiety, and sleep problems. Some patients have changes in the painful area that are known as trophic changes. These include wasting away of the skin, tissues or muscle, thinning of the bones, or changes in how hair or nails grow.

Every patient with complex regional pain syndrome has different symptoms. Your symptoms can change from minute-to-minute or hour-to-hour. Your doctor makes the diagnosis of complex regional pain syndrome based on how you describe your symptoms and on the findings from your physical exam.

Treatments for Complex Regional Pain Syndrome

No single treatment can cure complex regional pain syndrome. But many patients find that their pain and other symptoms get much better with the right therapies. Every patient responds differently to each treatment. Your doctor may need to try many different therapies in different combinations to find the right one for you.

Your doctor may try you on drugs like nonsteroidal anti-inflammatory drugs, corticosteroids, anticonvulsants, antidepressants or opioids. You may have to take several different drugs together to get the best pain relief.

Another therapy is called a sympathetic nerve block. Most patients with complex regional pain syndrome should get at least one block. Some patients get dramatic pain relief. If you don’t get good relief from the block, you should probably not continue with this therapy.

Many patients find physical or occupational therapy helpful. A program of stretching, strengthening and aerobic conditioning had help you get back range of motion, strength and motor control. It is a very important part of treatment.

Occasionally, patients get good pain relief from a block but it doesn’t last long. In this situation, your doctor may suggest a sympathectomy. This means damaging the sympathetic nerves that lead to the painful body part using surgery or chemicals. Other treatments include acupuncture, TENS transcutaneous electrical nerve stimulation, spinal cord stimulation, and intraspinal infusion.

Patients who have pain caused by clothing, wind, cold or light touch may find desensitization helpful. The skin is rubbed with different materials, starting with soft, light textures and moving on to rough, irritating surfaces. Eventually the skin gets used to rough textures. The patient can then deal with the touch of clothing or sheets or towels.

We hope this segment has provided you with some basic information about complex regional pain syndrome. Remember, with all the treatment choices available, there’s every reason to stay hopeful that your problem can be helped.