Complex Regional Pain Syndrome – CRPS11/01/2021 2021-01-11 14:18
Complex Regional Pain Syndrome – CRPS
Complex Regional Pain Syndrome – CRPS
It came suddenly, and I ignored it for a while, then it became unbearable. It then became a frequent visitor that affected my day to day activities.
First, it was my leg; then it was my hands. I was only 30 years old at that time. I asked myself, ” Is this part of aging?” Is 30 that old? I have so many questions that puzzled my brain. The pain was numb and, at times, unbearable. I had no swelling, no trauma at the site, no bruising, no deformity, and nothing at all. Then why did I have this dreadful pain? After going to many providers and going inside many machines, finally, one provider found out what was wrong with me. I didn’t even realize it until my doctor told me, ” your symptoms started after the car accident that was almost two years ago” My doctor told me I have complex regional pain syndrome. I might have the pain for the rest of my life because there is no cure for it. Meaning it can be a chronic condition that only has symptomatic therapy. The four-letter word that will stay with me for the rest of my life.
Complex regional pain syndrome
The CRPS (complex regional pain syndrome, a neurological condition) is a type of chronic pain that typically affects the arm or leg. After an injury, an operation, a stroke, or a heart attack, CRPS usually develops. The discomfort is out of proportion to the seriousness of the initial injury. CRPS is rare, and there is no clear explanation of its origin. When begun early, therapy is most successful. Improvement and even remission are probable in such situations.
Types of CRPS
CRPS occurs in two forms, with signs and symptoms identical to each other but with different causes:
Type 1 CRPS: Type 1 Complex Regional Pain Syndrome or Reflex Sympathetic Dystrophy (RSD) is a clinical condition of the variable course and an unexplained cause characterized by pain, swelling,
and extremity vasomotor dysfunction. It occurs after an illness or accident that has not specifically harmed the nerves in the affected limb. Around 90 percent of CRPS individuals have type 1 CRPS.
Type 2 CRPS: Type 2 Complex Regional Pain Syndrome or Causalgia arises after a trauma or injury to a peripheral nerve. Peripheral nerves pass from your spine and brain to your extremities.
“Brachial plexus” is the most prominent site of CRPS II pain. This is the group of nerves that run from your neck to your arm. CRPS II is rare, affecting slightly less than 1 out of 100,000 Trusted Source individuals.
Causes of CRPS
The peripheral C-fiber nerve fibers that bring pain signals to the brain are triggered by most CRPS diseases by the nerve fiber’s inappropriate function. They are over firing and often induces inflammation aimed at encouraging healing after an injury and rest. The nerve damage is apparent in some individuals, but in others, a specialist may be required to find the injury and treat it.
Complex regional pain syndrome (CRPS) is rare, and there is no clear explanation of its cause. After an accident, heart attack, or stroke, CRPS usually develops. Researchers predict that CRPS can occur in 2-5 percent of those with peripheral nerve damage and 13-70 percent of those with hemiplegia, i.e., paralysis of one side of the body. Furthermore, several studies have shown that cigarette smoking is substantially present in patients and is statistically related to RSD. This may be seen in its pathology by other unknown neurotransmitter-related mechanisms or by boosting the sympathetic activity and vasoconstriction and. This hypothesis was based on a retrospective study of 53 RSD patients, which found that smokers accounted for 68% of patients and just 37% of controls. The findings are provisional and are constrained by their retrospective character. It is later formed in another limb by 7% of people who have CRPS in one limb. CRPS may also arise from other major and minor traumas, such as surgery, heart attacks, infections, and even sprained ankles.
What are the typical symptoms of CRPS?
Most people do not have all of these mentioned symptoms, and during recovery, the number of symptoms usually decreases.
- Unprovoked or spontaneous pain that can fluctuate with activity or be constant. Some say it feels like a sensation of “burning” or “pins and needles” or as if it were squeezing the affected limb. Over time, pain can spread to most or all of the arm or leg if the nerves remain chronically inflamed, even if the initially affected region was smaller. Pressure and other signs arise in a matching position on the opposite limb in rare cases. The secondary involvement of spinal cord neurons (nerve cells) is reflected as “mirror pain.” Mirror pain is less intense as the affected nerves heal; it resolves.
- Following the use or touch, excess or persistent pain in the affected region is known as allodynia. Increased sensitivity in light touch, regular physical contact, and use are found to be very painful by the person. Some note extreme or persistent discomfort after a mildly painful stimulus like a pinprick is known as hyperalgesia.
- Changes in the skin color, skin temperature changes, or swelling of the affected leg are seen. It may feel warmer or colder than the opposite limb in the injured arm or leg. The skin can change color, becoming blotchy, blue, purple, green, pale, or red on the affected limb. These skin symptoms usually fluctuate as they show abnormal blood flow in the area. The C-nerve fibers that are damaged in CRPS control the opening and closing of the small blood vessels under the skin.
- Modification of skin texture: Over time, inadequate oxygen and nutrient distribution may cause the skin to alter the texture of the affected limb. It becomes shiny and thin in some circumstances, thick and scaly in others. Washing painful skin or avoiding contact leads to this alteration.
- Abnormal sweating and hair and nail growth: On the affected limb, hair and nails may grow very quickly or not at all, and in some people, patches of profuse sweating or no sweating are seen. These are under neural regulation and are affected by the circulation of local blood.
- The rigidity of the affected joints: This is a common issue in which the decreased movement contributes to reduced tendon and ligament flexibility. Tight tendons or ligaments sometimes rub or pinch nerves to provide an internal cause of CRPS in individuals who do not have any external injuries.
- Wasting away or excess bone growth. Bones receiving signals from the damaged nerves barely become affected in CRPS-affected limbs. On X-rays or other imaging, these anomalies are often apparent, helping doctors assess the location of nerve damage and locate the best treatments. Rough or swollen areas of bone may irritate passing nerves and initiate or prolong CRPS, such as after a bone cyst or from a poorly healed fracture.
- Impaired muscle strength and movement. Most individuals with CRPS have no direct damage to the nerve fibers that govern the muscles that coordinate the muscular movement of the body. Most studies, however, have limited the capacity to move the affected part of the body. This is typically due to discomfort and sensory feedback abnormalities that aid in controlling movements. Even for muscles, excess inflammation and inadequate circulation are not good. Unusual movement in the affected limbs, fixed abnormal posture called dystonia, and tremors or jerking are rarely recorded by patients. This may represent the secondary propagation to the brain and spinal cord of disrupted neural activity. During CRPS recovery, most resolve themselves, but some individuals need orthopedic surgery to lengthen contracted tendons and regain normal flexibility and position.
Signs and symptoms of CRPS go away on their own in certain individuals. In others, for months to years, signs and symptoms can persist. When begun early in the course of this disease, treatment is likely to be most successful.
How is CRPS diagnosed?
No particular test will confirm CRPS and identify the nerve that has been damaged. Diagnosis includes:
- A systematic assessment by a specialist who is familiar with typical sensory nerve pathology trends, such as a neurologist, orthopedist, or plastic surgeon. By having patients draw the outline of their most abnormal skin, the damaged nerve is also exposed.
- Nerve conduction tests diagnose some but not all CRPS-associated nerve injuries (some injuries involve tiny nerve branches that cannot be detected this way).
- The imaging of nerves by ultrasound or magnetic resonance imaging (MRI), also known as magnetic resonance neurography (MRN), also reveals underlying nerve damage. The affected nerve can be detected by characteristic MRI defects of the bone and bone marrow.
- Triple-phase bone scans (using a dye) also reveal CRPS-associated excess bone resorption (natural breakdown and reintegration into the body of bone tissue), which can help with diagnosis and localization.
- As CRPS typically develops over time, it is easiest to diagnose and should not be delayed at an early stage of the disease.
How is CRPS treated?
Most early or mild cases recover by themselves. When begun early, therapy is most successful.
Extensively used key therapies include:
- Recovery and Physical Therapy. This is the single most significant treatment for CRPS. Holding the painful limb or movement of the body part increases blood flow and decreases circulatory symptoms while retaining flexibility, strength, and function. By rehabilitating the injured leg, it helps stop or reverse secondary spinal cord and brain changes associated with disuse and chronic pain. Occupational therapy can allow people to find new ways to get engaged and return to work and everyday activities.
- With psychotherapy. People with extreme CRPS also experience secondary psychological problems, including depression, situational anxiety, and recurrent post-traumatic stress disorder. This enhances pain tolerance, further decreases movement and brain function, and makes it more difficult for patients to receive medical care and engage in recovery and rehabilitation. Psychological care helps people with CRPS to feel better and better at recovering from CRPS.
- Graded motor imagery. Mental exercises are taught to people, including how to distinguish painful left and right body parts when looking in a mirror and imagine moving certain painful parts of the body without actually moving them. This is thought to provide the brain with non-painful sensory feedback that helps reverse brain changes that prolong CRPS.
Several groups of medication have been reported as effective for CRPS, especially when administered early in the illness. However, none of these are accepted by the U.S. It is to be marketed solely for CRPS by the Food and Drug Administration (FDA), and it is not guaranteed that any single drug or combination is effective for all. Drugs that are broadly used for the treatment of CRPS include:
- Acetaminophen reduces pain associated with inflammation and bone and joint involvement.
- With sufficient doses of over-the-counter aspirin, ibuprofen, and naproxen, non-steroidal anti-inflammatory drugs (NSAIDs)are used for the treatment of moderate pain and inflammation.
- For other neuropathic pain conditions, medications such as nortriptyline, gabapentin, pregabalin, and duloxetine have been shown to be helpful. Amitriptyline, an older drug, is successful but produces more side effects than nortriptyline, which is somewhat similar in terms of chemistry.
- Local topical anesthetic ointments, sprays, or creams such as lidocaine and fentanyl-like patches. This can decrease allodynia, and additional protection can be offered by skin coverage via patches.
- Bisphosphonates that minimize changes in the bone, such as high-dose alendronate or intravenous pamidronate.
- Corticosteroids, including prednisolone and methylprednisolone, treat inflammation/swelling and edema.
- In severe cases, botulinum toxin injections may help, particularly to relax contracted muscles and to restore normal hand or foot positions.
- Individuals with the most serious pain may need medications such as oxycodone, morphine, hydrocodone, and fentanyl. Opioids, however, may convey greater sensitivity to pain and run the risk of dependency.
- Controversial, unproven therapies include N-methyl-D-aspartate (NMDA) receptor antagonists like dextromethorphan and ketamine.
- Neridronic Acid: The cause of CRPS is unknown, but the outcome is generally thought to be that the body responds abnormally to an injury. Because some cases may be undiagnosed or misdiagnosed, it is difficult to determine just how widespread CRPS is currently; no licensed CRPS therapies exist. Neridronic acid injection is currently being used to treat CRPS, and early findings indicate that it has the ability to control the disease. When neridronic acid has been approved, a potential new treatment for CRPS would be considered.