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

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