Complex Regional Pain Syndrome (CRPS): What It Is, Causes, Symptoms & Treatments

Complex regional pain syndrome (CRPS) sounds scary but, thankfully, it's rare.

Around 200,000 Americans get it every year, according to the Cleveland Clinic. CRPS is a kind of pain that tends to linger, usually in your arms, hands, legs or feet. This article will help you know what makes it happen, what signs to watch for, and how doctors can help.

What is complex regional pain syndrome (CRPS)?

The Mayo Clinic says that CRPS happens after things such as injuries, surgeries, strokes or heart attacks. What's strange is that the pain can be much worse than the first bout of illness.

Dr. Nick Rose, a hand and wrist surgeon with the Hoag Orthopedic Institute in Southern California, adds that CRPS is “an abnormal response to an injury that causes many of the body's systems to malfunction. Fortunately, true CRPS is very rare, occurring in about 5 out of 100,000 persons per year... The exact cause of CRPS remains unknown, but it typically follows trauma to the hand, foot or limb. Crush injuries, fractures, sprains, lacerations, a tight cast, nerve injury and even an infection or heart attack can lead to CRPS.”

Causes of complex regional pain syndrome

Why some people get CRPS while others with similar injuries don't remains a mystery. The U.S. National Institute of Neurological Disorders and Stroke says that in over 90% of cases, CRPS is started by nerve damage in the hurt limb. This damage usually affects the thinnest sensory and autonomic nerve fibers.

Here are the most common things that can lead to CRPS:

• Fractures: This happens a lot, especially in the wrist. When bones break in a certain way, they can hurt nerves or press on them when put in a cast.
• Surgery: Sometimes, even when surgery goes well, things like incisions, stitches or how you're positioned during surgery can hurt nerves.
• Sprains/strains: When joints are stretched too much due to injuries like sprains, nearby nerves can get hurt.
• Minor injuries like burns or cuts: Even small injuries that you can see might hurt nerves underneath.
• Limb immobilization: Putting a cast on a limb can sometimes hurt nerves and reduce blood flow, causing CRPS.
• Rare penetrations: Sometimes cuts or needle pricks can accidentally hurt a nerve. Specialists can help find these hurt nerves and fix them with surgery.

Complex regional pain syndrome symptoms

Rose shares the following common symptoms of CRPS:

• Continuous pain that is disproportionate to the original injury
• Hyperalgesia (heightened sensitivity to pain)
• Allodynia (pain due to a stimulus that normally doesn't produce pain)
• Burning pain in the hand, arm, leg or foot
• Swelling
• Tremors or spasms
• Stiffness
• Skin color changes
• Differences in skin color between the two limbs
• Changes to the skin, hair and nails on the affected limb
• Temperature differences between the two limbs
• Sweating difference between the two limbs
• Weakness
• Atrophy (muscle-wasting)

Complex regional pain syndrome types

CRPS isn't the same for everyone. Stanford Medicine's Division of Pain Medicine splits it into two groups:

Type 1 (sympathetic dystrophy): This type appears even without clear nerve damage. Your body's pain system gets confused without an obvious reason.

Type 2 (causalgia): For this type, a specific nerve has been hurt. It's as though your body's pain system is on high alert because of the nerve damage.

Both types can be challenging for patients to contend with, but doctors can help you determine which one you might have and find the best way to improve the pain.

Complex regional pain syndrome treatment

For the best chance at finding relief from CRPS, Rose suggests partnering with a team of health care experts, including a hand surgeon, pain management specialist, occupational hand therapist and possibly a psychologist or psychiatrist.

A combined approach is often best to help with pain management.

Complex regional pain syndrome medications

• Anticonvulsants: Drugs like Gabapentin or Pregabalin can help control nerve-related pain.
• Corticosteroids: These reduce inflammation and might ease pain.
• Antidepressants: Not just for mood; they can help pain, too.
• Opioids: Strong pain relievers can be used cautiously when others don't help.
• Sympathetic Nerve Blocks: Shots can help stop pain signals.

Complex regional pain syndrome self-care

• Biofeedback therapy: Learning to control body responses to reduce pain.
• Relaxation skills: Techniques to calm both body and mind.
• Quitting smoking: This is helpful if you smoke, as smoking worsens CRPS.
• Cognitive behavioral therapy: Changing thoughts to manage pain better.
• Treating psychological issues: Tackling anxiety and depression that can come with CRPS.

Complex regional pain syndrome procedures

• Surgical decompression of scarred/compressed nerve: This surgery aims to relieve pressure on a nerve trapped or damaged by scar tissue or other factors.
• Secondary surgery: This refers to an additional surgery once CRPS symptoms are managed, to improve the affected area's movement and function.
• Stellate ganglion blocks: These are medication injections near the neck's stellate ganglion, a nerve bundle, to help reduce pain and improve blood flow to the affected limb.
• Spinal cord stimulator: A device implanted near the spine that sends electrical signals to block pain messages, used in select cases where other treatments haven't been effective.

Living with complex regional pain syndrome

Acting quickly makes a difference when you're dealing with CRPS. Getting diagnosed and treated early gives you the best shot at a full recovery. Follow your health care provider's advice on pain medicines and any therapy, which can greatly help. Johns Hopkins Medicine suggests that moving the painful body part can improve blood flow, ease symptoms and boost flexibility, strength and function. Occupational therapy can also teach you new ways to tackle work and daily tasks.

Remember, always check with your health care provider before trying any new treatments.

Resources

Nicholas Rose, MD, hand and wrist surgeon, Hoag Orthopedic Institute, Southern California

Cleveland Clinic: Complex Regional Pain Syndrome (CRPS)

Mayo Clinic: Complex Regional Pain Syndrome

U.S. National Institute of Neurological Disorders and Stroke: Complex Regional Pain Syndrome

Stanford Medicine, Division of Pain Medicine: Complex Regional Pain Syndrome (CRPS)

John Hopkins Medicine: Complex Regional Pain Syndrome

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