CRPS, formally known as regional sympathetic dystrophy or causalgia, is a chronic pain syndrome that usually affects the arms or legs. Increased signaling within the nervous system, known as neuropathic pain, causes CRPS.
Symptoms of CRPS include increased pain to touch, skin temperature changes, skin color changes, swelling, sweating and decreased range of motion in joints. In addition, CRPS can cause changes to the growth of hair, fingernails and toenails. Because it is diagnosed by a group of symptoms, CRPS has no single diagnostic test.
Unfortunately, there is no known cure for CRPS. Therefore, treatments are aimed at improving symptoms of the disease. Treatments are often multimodal in nature, which means that patients may be referred for specialized physical therapy. In addition to physical therapy, patients are often prescribed a combination of medicines to control their pain. These medications target the pain caused by CRPS in different ways. CRPS patients are also often referred to psychologists who specialize in cognitive behavioral therapy for patients with chronic pain.
If medication and physical therapy prove unsuccessful at adequately treating CRPS pain, injection therapies known as stellate ganglion blocks and lumbar sympathetic blocks may be utilized. These nerve blocks target specific areas in the nervous system with the goal of decreasing the pain caused by CRPS and improving the patient’s quality of life. An additional type of treatment known as neuromodulation is often employed for patients with CRPS, in which electrodes are placed near the spinal cord to help control the pain and symptoms of CRPS.
Neuropathic pain results from injury and disease in the neurons (signaling pathways), which lead to changes in the ways signals are processed by the brain. When nerves become damaged, negative and positive symptoms occur. Numbness is considered a negative symptom, and pain as a response to something that would not normally cause pain (allodynia) is considered a positive symptom. Other signs and symptoms include pain caused by normal weight bearing, movement and deep pressure.
Neuropathic pain is usually described as a burning, stabbing or cramping sensation. Causes include post-herpetic neuralgia (shingles), painful peripheral neuropathy, failed back surgery syndrome, chronic regional pain syndrome and post-thoracotomy pain.
- Post-herpetic neuralgia is caused by the chickenpox virus.
- Painful peripheral neuropathy refers to conditions that result when the nerves that carry messages to and from the brain and spinal cord onto the rest of the body are damaged or diseased.
- Failed back surgical syndrome refers to patients who have persistent pain after spinal surgery.
- Chronic regional pain syndrome (CRPS) is a type of pain that develops after an injury, a surgery, stroke or heart attack in an arm or leg.
- Post-thoracotomy pain is pain that recurs or persists along a thoracotomy (an incision in the chest between ribs) incision
Procedures performed for neuropathic pain include:
- Nerve blocks. Nerve blocks (injecting local anesthetic +/- steroid) are usually performed for diagnostic and therapeutic reasons as they can help confirm or rule out the pathway of the pain as well as provide adequate pain relief.
- Peripheral nerve stimulation
- Spinal cord stimulation
- Dorsal root ganglion stimulation
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