Complex Regional Pain Syndrome

What is complex regional pain syndrome (CRPS)?

• Complex regional pain syndrome (CRPS) is an illness that is described as having pain for longer and in excessive amounts compared to what is normal
• Typically after an injury to an arm or leg.
• Although it sometimes improves on its own, there are instances where the condition is chronic and very disabling.

How does complex pain syndrome occur?

• CRPS occurs after an injury to the arm or leg, although the condition has been noted to occur at other parts of the body, albeit more rarely. 
• Type I is not related to any nerve injury. 
• Type II is correlates to the same area of nerve damage.

Who is prone to CRPS?

• Women are afflicted more than men
• Peak affected age is 40
• Rare in children or the elderly

What is the outcome of Complex regional Pain Syndrome?

• Variable outcomes
• Most recover over time, occasionally taking years
• Some correlation with recovery of the injured nerve
• CRPS can lead to long-term disability if not treated early
• Young children and teenagers as well as the elderly tend to recovery
• Young adults and middle aged adults tend not to do as well
• Smoking, diabetes and a history of chemotherapy as well as some autoimmune conditions can affect healing and recovery

What are the complications of CRPS?

• The bones and muscles weaken and the joint will become painful or stiff, making it hard to move or walk
• The skin, hair and nails become discoloured, the area becomes swollen
• As the muscles become tightened for a prolonged period, the hands or feet cane become permanently deformed

How do we prevent CRPS?

• Early physiotherapy and mobilisation and treatment
• High dose Vitamin C

How can we treat CRPS?

• Physiotherapy and exercise to prevent stiffness and contractures, and to prevent detrimental changes in the nervous system 
• Occupational therapy to aid the patient in coping with the condition and living as normally as possible
• Psychotherapy to manage the anger, anxiety and depression, as well as the negative thoughts that perpetuate CRPS
• Medications:
  • Amitriptyline and Nortriptyline
  • Duloxetine and Venlafaxine
  • Gabapentin and Pregabalin
  • Lignocaine patch and Capsaiccin
  • Opioids
  • NSAIDs and Etoricoxib, Celecoxib
  • Targeted injections
• Pain procedures:
  • Sympathetic nerve blocks
    • can be very effective in some patients
  • Pulsed radiofrequency of the dorsal root ganglia
    • Seeks to ‘reset’ the abnormal sensitivity of the nerve
    • Can be done as a day procedure
  • Spinal cord stimulation
    • A more permanent solution where an electrode and battery pack is placed in your body
  • Intrathecal pumps
    • For those who require high doses of opioids but are unable to tolerate their side effects
• Others:
  • Acupuncture
  • Mirror-box therapy and graded motor imagery
  • Intravenous immunoglobulin