Issue 47.13
Complex regional pain syndrome (CRPS) is a form of chronic pain that is caused by debilitating neuropathic disease. It often starts after a traumatic injury or surgery and the pain is out of proportion to the original injury. Symptoms include abnormal hair/nail growth, swelling, temperature changes, color changes of the skin, weakness, decreased range of motion, sensitivity to touch and intense burning pain at the affected site.
There are two major factors associated with CRPS. The first is that of hyperalgesia, which is extreme sensitivity to a normally painful stimuli. An example would be like being pinched. This would cause pain, but usually for only a short period of time. In a patient with CRPS this sensation would cause prolonged intense pain. The second is that of allodynia. Allodynia is described as pain experienced by something that normally would not cause pain. For example, a bed sheet brushing over the skin affected by those with CRPS would cause an intense burning pain or discomfort.
Medical literature suggests that earlier diagnosis and treatment will lead to better outcomes. Although there is no cure for CRPS there are multiple options for the patient. These include active mobilization physical therapy, pharmacological therapy, sympathetic nerve blocks and possible spinal cord stimulation. Your surgeon or primary care physician would start with the physical therapy and some type of medication treatment. If these fail to address the problem a referral to a pain management center may be made for sympathetic nerve blocks or consideration of a spinal cord stimulator.
Providers use various types of medications to treat CRPS. Various over the counter medications such as Tylenol, Ibuprofen or naproxen are often used for pain and inflammation. Prescription strength pain relievers may also be an option. Antidepressants such as amitriptyline and cymbalta are a consideration as are anticonvulsants, such as gabapentin, which are used to help with the nerve pain.
Sympathetic nerve blocks target a group of nerves which are part of the autonomous nervous system. These spread to your body that help with involuntary function. This procedure is done in a series of injections under fluoroscopy (live x-ray) and medication is injected to help reduce the pain. These injections may be repeated if and when the CRPS symptoms return or worsen.
A spinal cord stimulator is a device that is surgically implanted that helps to lessen the intensity of pain. This is done by placing small electrodes within the spinal canal region to help lessen the pain signal traveling from the affected limb to the sensors in the brain. The result is a tingling sensation rather than the pain. Prior to having the permanent device placed a 4-5 day trial would be performed. This is done as an office procedure in a fluoroscopy suite at a pain management office. During the trial period 50% improvement is needed to proceed with permanent placement.
Dealing with chronic pain can be a frustration on our physical and mental health. If you feel like you may suffer from CRPS talk with your health care provider to begin final diagnosis.
Cortney Bernardo can be contacted at Desert Pain Specialists, 435-216-7000.