Definition
A form of chronic pain that usually affects an arm or leg. CRPS= typically develop after an injury a surgery a stroke or heart attack. The pain is out of proportion to the severity of the initial injury. It is uncommon and its cause is not clearly understood. It affects about 200,000 people every year in USA.
Causes:
Type 1 also known as RSD. It occurs after an illness or injury that did not directly damage the nerves in the affected limb. 90% of people with CRPS have this type.
Type 2 also known as causalgia. It occurs after a distinct nerve injury.
Most cases occur after he forceful trauma to an arm or leg. This can include a crushing injury or fracture. The pathology may be due to dysfunction in either your central or peripheral nervous system leading to inflammatory or immune responses.
Symptoms:
• Continuous burning or throbbing pain, usually in the arm, leg, hand or foot
• Increased sensitivity to touch or cold
• Swelling of the painful area
• Changes in his skin temperature alternating between cold and sweaty
• Changes in skin color ranging from white and blotchy to red or blue
• Changes in hair and nail growth
• Joint stiffness, swelling and the damage
• Muscle spasm, tremors and weakness
• Decreased ability to move the affected body part
CRPS occasionally may spread from its source to elsewhere in the body such as the positive limb. In some cases, signs and symptoms may go away on their own, while in others, it may persist for months to years.
Diagnosis:
There is no specific test to diagnose CRPS.
• A careful history, physical exam and review of symptoms.
• Ultrasound, MRI to look for underlying nerve damage, Bone scan, EMG/NCS to detect nerve injury. Bone densitometry can also be used to detect changes in bone mineral density. It can also be used to monitor the results of treatment since bone densitometry parameters improve with treatment.
Treatment: VIT C supplement may be useful to prevent the syndrome after fractures.
• Physical therapy has low evidence in the treatment.
• PTENS units can be helpful to manage Pain and Edema.
• PTentative evidence supports the use of bisphosphonates, calcitonin, and ketamine. Nerve blocks with guanethidine appear to be harmful. Evidence for sympathetic nerve blocks generally is insufficient to support their use Intramuscular botulinum injections may benefit people with symptoms localized to one extremity.
• PSpinal cord stimulation appears to be an effective therapy in the management of patients with CRPS type I (level A evidence) and type II (level D evidence). Although they improve patient pain and quality of life, evidence is unclear regarding effects on mental health and general functioning.
• PDorsal root ganglion stimulation is a type of neurostimulation that is effective in the management of focal neuropathic pain. The FDA approved its use in February 2016. The ACCURATE Study demonstrated superiority of dorsal root ganglion stimulation over spinal (dorsal column) stimulation in the management of CRPS and causalgia.
• PCannabidiol (CBD), despite evidence of very low quality, is proposed to relieve pain.