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APM Spine & Sports Physicians

Complex Regional Pain Syndrome (Reflex Sympathetic Dystrophy)

What is complex regional pain syndrome?

Complex regional pain syndrome (CRPS), previously called reflex sympathetic dystrophy (RSD), is a chronic disorder in which nerves misfire, constantly sending pain signals to the brain. Because of these effects, it can cause life-altering changes. If not treated, CRPS can cause stiffness and loss of use of the affected part of the extremity.

One form of CRPS results from changes in the sympathetic nervous system that controls the blood flow and sweat glands in the extremities. When the nervous system becomes overactive, burning pain can felt and subsequent swelling and warmth can be left in the affected extremity.

How is CRPS classified?

Complex regional pain syndrome is the now the official name from the World Health Organization for reflex sympathetic dystrophy (RSD) and causalgia. The syndrome is divided into two categories as follows:

  • CRPS Type 1 (Reflex Sympathetic Dystrophy) – This is caused by a simple known injury, such as a simple fall, fracture, or minor surgery. As a result of this, a nerve or tissue is injured. Instead of expected pain, the pain that results is not consistent with the injury and does not respond to pain medication. The pain will usually spread upward from the injury site. The pain may persist for months or years and usually will be much worse at night.
  • CRPS TYPE 2 (Causalgia) – This is caused by a nerve or tissue injury that is affected by a known ongoing abnormality, such as a lesion or tumor, and the resulting damage does not heal or resolve. The symptoms are the same as in Type 1 (RSD). The only difference is the cause.

What are the symptoms of CRPS?

The symptoms that result from both types of CRPS can include but are not limited to:

  • Intense, persistent burning pain
  • Abnormal excessive sweating
  • Muscle spasms near the affected area
  • Change in skin, hair, or nails (dry, brittle, shiny, coarse, or scaly)
  • Stiffness
  • Extreme sensitivity to touch
  • Changes in bone and skin
  • Numbness
  • Movement disorder in the affected limb
  • Atrophy in the affected limb
  • Occasional coldness or coolness in the affected limb
  • Swelling of the affected limb
  • Headaches
  • Nausea
  • Insomnia
  • Lethargy
  • Recurrent infections
  • Depression

What kinds of treatments are prescribed?

The sooner CRPS is diagnosed and treatment begun, the better the chances of complete recovery. Among the treatments we may prescribe are:

  • Epidural or sympathetic nerve block
  • Physical and/or occupational therapy to help restore normal movement to affected limbs. Office treatments may also include electrical stimulation, ultrasound, contrast baths, TENS (Transcutaneous Electrical Nerve Stimulation) unit, re-sensitization, and pool therapy.
  • Prescribed medications that may include a clonidine patch (Catapres®), oral opiates, Conazepam or Lioresal®, anti-epileptic medications for constant or paroxysmal pain, and antidepressants for membrane stabilization of nerve endings.
  • Spinal cord stimulation when symptoms persist despite appropriate treatment
  • Surgical sympathectomy (a procedure that interrupts nerve impulses) in extreme cases when no lasting relief has been obtained by more conservative measures