I was diagnosed with Complex Regional Pain Syndrome (CRPS) last year. My CRPS was triggered by surgery however, even minor injuries can be responsible, but the pain tends to be greater than would be expected from the type of injury sustained. This is a complex and poorly understood condition.
CRPS is a chronic pain condition that is believed to be the result of dysfunction in the central or peripheral nervous systems and occurs when the part of the sympathetic (unconscious) nervous system that controls blood flow is disturbed and becomes overactive. Burning pain, swelling, stiffness and discolouration of the affected limb(s)
Often, the exact reason for CRPS remains unknown, although is often catorgarised by type 1 or type 2. Type 1 is without nerve injury formally known as Reflex Sympathetic Dystrophy and type 2 is due to nerve injury, this was formally caused causalgia. I have type 2.
Diagnosis of CRPS is clinical and may be difficult, especially in the early stages especially within CRPS type 1 where there is no evidence of a prior injury or physical problem. Generally, the diagnostic criteria is accepted as being a history of a noxious event or immobilisation (CRPS I) or a nerve injury (CRPS II) of the affected area associated with pain that is disproportionate to the inciting event plus one or more of the following:
Abnormal function of the sympathetic nervous system
Evidence of swelling at some point in time since injury
Movement disorder
Changes in tissue growth (dystrophy and atrophy)
Absence of any condition that could cause this degree of pain or dysfunction
Patients present in complex and varied ways, the one common factor being pain. This may result in the patient being labelled as a malingerer or there may be suspicion that it is a ploy to obtain opiate analgesia. I was told I was lazy and that I couldn't be in that much pain. It was only when I sat in the doctors office crying and begging for him to amputate my leg as it was so horrendously painful that they started to listen.
The process of CRPS involves three stages.
The initial acute stage, which may last up to a few months, causes pain, often described as burning, and excess sweating in the affected part of the limb, which also becomes warm and red. During this stage, someone with CRPS may notice their hair and nails grow faster than usual. The joints of the affected limb may become painful, too.
Stage two can last up to a year and is known as the dystrophic stage. During this, the affected limb may be constantly swollen, causing wrinkles in the skin to disappear. Fingernails become brittle, and the pain and stiffness spread up the limb and along the same side of the body, or may spread to the opposite limb.
At the final stage of CRPS stage three - the atrophic stage. The muscles may waste away and the skin usually becomes stretched, shiny and pale. The pain may lessen but is constant, and the part of the body affected is stiff. The skin may also be hypersensitive to touch. Once this stage has been reached, the chance of recovering movement diminishes.
The prognosis for CRPS varies from person to person. Spontaneous remission from symptoms occurs in certain individuals. Others can have unremitting pain and crippling, irreversible changes in spite of treatment. Because there is no cure for CRPS, treatment is aimed at relieving painful symptoms. Doctors may prescribe topical analgesics, antidepressants, corticosteroids, and opioids to relieve pain. However, no single drug or combination of drugs has produced consistent long-lasting improvement in symptoms. Other treatments may include physical therapy, sympathetic nerve block, spinal cord stimulation, and intrathecal drug pumps to deliver opioids and local anesthetic agents via the spinal cord. Treatment is generally most effective in the first three months of the condition. If left untreated the disorder can spread to other areas of the body. The usual pattern of spread is up the affected extremity and on to the same side of the body. It may also spread to the opposite side of the body. Specialist intervention early on is the key to a successful outcome.