Complex Regional Pain Syndrome (CRPS)

Complex Regional Pain Syndrome (CRPS) is a chronic pain condition that usually affects a limb after an injury, surgery, fracture or other tissue trauma. The pain is often more severe and persistent than would normally be expected from the original injury and may be accompanied by changes in sensation, skin temperature or colour, sweating, swelling and movement.

CRPS can significantly affect mobility and function. Early recognition and appropriate treatment may help prevent persistent disability and improve recovery.

Types of CRPS

CRPS, Type - I (Reflex Sympathetic Dystrophy) – Without confirmed evidence of a specific nerve injury.

CRPS, Type - II (Causalgia) – When there is evidence of a specific peripheral nerve injury.

Both types can produce similar pain and autonomic, sensory and motor changes.

Causes & Risk Factors

• The exact mechanism is not completely understood. Abnormal interactions between the peripheral and central nervous systems, inflammatory processes and the autonomic nervous system are thought to contribute.
• CRPS often develops after an injury or procedure affecting an arm, hand, leg or foot.
• Common triggers include:
• Fractures, particularly wrist or ankle fractures
• Surgery
• Sprains and ligament injuries
• Soft-tissue injuries
• Nerve injuries
• Crush injuries
• Prolonged immobilization
• Occasionally, even a relatively minor injury

Symptoms

• Symptoms can vary between patients and may change over time.
• Severe, burning, shooting or throbbing Pain that is disproportionate to the original injury
• Hyperesthesia – Increased sensitivity to Touch or Pressure
• Allodynia – Pain from normally non-painful stimuli, such as light touch, clothing or bedsheets
• Hyperalgesia – Increased response to painful stimuli
• Tingling or numbness
• Swelling of the affected limb
• Changes in Skin Colour or Temperature
• Increased or Reduced Sweating
• Abnormal Hair or Nail Growth
• Muscle stiffness or weakness
• Reduced range of motion
• Difficulty using or bearing weight on the affected limb

Autonomic Vasomotor, Thermal & Sudomotor Skin Examination

Fluoroscopic C-Arm Guided Sympathetic Ganglion Block

How Complex Regional Pain Syndrome (CRPS) is Diagnosed?

There is No single test that confirms CRPS.

Diagnosis is primarily clinical and is based on the patient's history, symptoms and physical examination.

The Budapest diagnostic criteria are commonly used to assess the characteristic sensory, vasomotor, sudomotor/oedema and motor/trophic features of CRPS.

1. Investigations such as X-rays, MRI, nerve conduction studies or other tests may be used selectively to support the diagnosis or rule out other conditions, depending on the clinical presentation.

Treatment Options for Complex Regional Pain Syndrome (CRPS)

Treatment is individualized and is generally most effective when started early. The goals are to reduce pain, restore movement and function, prevent complications and improve quality of life.

Physiotherapy & Rehabilitation – Gradual movement, desensitization, stretching, strengthening and functional rehabilitation are important components of treatment. Therapy aims to restore normal use of the affected limb while avoiding prolonged immobilization.

Heat or Cold Therapy – help reduce pain, swelling and discomfort in selected patients with CRPS.

Transcutaneous electrical nerve stimulation (TENS) – Mild electrical impulses to the nerve endings, blocking pain signals from reaching your brain.

Medications – Depending on the symptoms and stage of the condition, medications may include Analgesics, Antidepressants and anticonvulsants.

Psychological Support – Chronic pain can affect sleep, mood and daily functioning. Psychological and behavioural strategies can help patients develop effective pain-coping skills.