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Complex Regional Pain Syndrome

What is Complex Regional Pain Syndrome?

Complex Regional Pain Syndrome is also sometimes known as Reflex Sympathetic Dystrophy, Sudeck’s Atrophy, Shoulder Hand Syndrome or Causalgia. It is a condition that commonly affects the arm (and can also impact the foot, or leg). CRPS is typically characterised by debilitating pain, that is greater than would be expected than the injury that caused it in the first place. Such injuries typically include a car accident or worker injury, while heart attack, or a stroke or surgery are also linked by CRPS. Patients with CRPS also have increased risk of anxiety, depression and suicide risk* due to the extent of the ongoing pain.

What are the different types of CRPS?

There are two types of CRPS.
Type 1 Acute occurs after illness or injury that did not directly damage a nerve in the affected area.
The overwhelming majority of people with CRPS have this type.
Type 2 Dystrophic has similar symptoms, but follows a distinct nerve injury. Both types of CRPS have the same three stages of disease.

1 The Acute stage.
This usually lasts up to three months and causes severe burning and throbbing pain that can be exacerbated by even the slightest touch, along with changes in skin colour and the skin may appear shiny, thin, red, pale purple or mottled. The patient also often notices rapid growth of hair and nails, muscle spasms and increased sweating.

2 Stage 2 Dystrophic
This stage lasts three to six months, and the level of pain increases as muscles weaken and joints stiffen. If untreated, this can progress to stage 3. 

3 Stage 3 Atrophic
If the condition remains untreated it becomes too painful or difficult to move the limb, causing muscles to atrophy and contract and these changes can be permanent. That is why it is extremely important to treat CRPS early.

What are the symptoms of CRPS?
CRPS symptoms include
– Intense, continuous burning or throbbing pain
– Stiffness
– Swelling
– Discoloration
– Changes in skin temperature
– Changes in hair and nail growth
– Joint stiffness, swelling and damage
– Anxiety and depression also often accompany CRPS

Who gets CRPS?
The root cause of CRPS is not known and is thought to be a result of general inflammation or inflammation of a person’s nerves. This in turn causes abnormalities in the central nervous system which changes the way in which we perceive any sensation in the affected area. CRPS usually occurs following an injury or a trauma that an individual has experienced for instance a car accident, worker injury, cancer, nerve injury or infection.
It tends to be common in middle age, typically affects women more often than men, but can also occur in children.

Does CRPS ever go away?
Like frozen shoulder (some studies suggest in fact that frozen shoulder is a form of CRPS), CRPS can go into remission with early treatment. But unlike frozen shoulder, which almost always resolves after 2 years, CRPS can linger for months, years or less commonly a lifetime. The key here is to treat early. CRPS rarely can spread elsewhere in the body, for instance the opposite limb.

How is CRPS diagnosed?
There is no definitive test to diagnose CRPS. Generally a patient history, examination, bone scan and imaging such as x-rays, MRI can help make a firm diagnosis.