Complex Regional Pain Syndrome
Complex regional pain syndrome is a chronic pain syndrome that can develop with or without an inciting event. It is often more severe than the original injury and can result in pain and functional loss of the affected extremity. It can be caused by a minor fracture, sprain or strain, or with no specific event whatsoever. It is most common in people aged 36-46 years and more common in females and in immobilized joints and tissues.
The pain is thought to be caused by sensitization of the sympathetic nervous system or an immune response which results in sensitization of primary nociceptor afferents resulting in the release of inflammatory mediators causing pain and local tissue breakdown.
• Erythematous or cyanosed blotchy skin
• Skin atrophy
• Skin edema occurs in up to 81% of patients
• Loss of normal skin creases
• Reduced or excessive sweating
• Increased or decreased temperature
• Restricted passive range of motion, contractures
• Muscle wasting and weakness
• Muscle spasms, dystonia, tremor
• Normal sensory stimuli causing pain known as allodynia
Other diseases that can mimic complex regional pain syndrome include:
• Neuropathy/neuropathic pain
• RadiculopathyOur Board-Certified Physicians Can Accurately Diagnose the Source of Your Pain
The first step in treatment is a trial of medication to decrease the symptoms. Medications that have been found to be helpful include gabapentin, tricyclic antidepressants, duloxetine, opioids, bisphosphonates, and prednisone. Also removing aggravating factors can also be helpful in calming down the abnormal nervous system response. Exercise is most often prescribed which is used to limit the loss of function of the extremity. These include joint range of motion, coordination/dexterity, compression devices for edema management and contrast bath for desensitization. If these conservative treatments are not helpful, innovative interventions such as sympathetic blocks and spinal cord stimulator can also be used.
Atkins RM.Complex regional pain syndrome.J Bone Joint Surg Br.2003 Nov;85(8):1100-6.