CRPS is a condition in which pain appears as a response to a previous injury, but rather than recovering over time, the condition becomes worse. You start to experience different symptoms, including skin discoloration which only serves to aggravate the situation even more. If you need help with CRPS, our specialists at Hollywood Healthcare & Diagnostic Imaging can offer treatment alternatives that can help relieve the pain. Contact our Los Angeles practice today.
What is Complex Regional Pain Syndrome (CRPS)?
CRPS, previously called causalgia or reflex sympathetic dystrophy/RSD), is a serious pain condition that some believe to be one of the world's most painful health conditions. Complex regional pain syndrome is considered to be a central or peripheral nervous system injury or flaw that emerges as severe pain as well as other physical symptoms in any or some of the limbs. If left untreated, the symptoms may persist for months or years and even become irreversible. There are numerous options for CRPS treatment, such as physical therapy.
The spinal cord and brain make up the central nervous system. The peripheral nervous system (PNS) comprises all of the nerves throughout the body besides the spinal cord and brain. Peripheral nerves transmit messages to and from the spinal cord and brain to various regions of our bodies.
It's thought that the first sign of CRPS is an injury to a peripheral nerve. The first injury that triggers CRPS could be as trivial as a needlestick injury or as serious as a fractured bone.
After the first injury, messages from the peripheral nervous system to the brain alert the individual to their injury. To begin the process of healing, the brain transmits signals to different body regions instructing them to release substances that will trigger a chain of physiological reactions. The body sends chemical compounds and nerve cues that result in swelling and elevated blood circulation to the affected region, as well as pain as the first steps it takes to defend and mend itself. These are standard phases of the process of recovery.
The main issue with CRPS is that the brain signals that cause swelling, pain, and elevated blood circulation never go away, even when the injury has fully recovered. The body is therefore deceived by the brain into thinking it's still injured when it isn't. The signals may intensify over time to the level where persistent, excruciating pain lasts for months, years, and sometimes indefinitely.
There's no obvious explanation for why some individuals who fracture their arms, for instance, develop CRPS while many others don't. However, they have discovered that women are more likely than men to develop CRPS, and also that the risk of developing CPRS increases when they reach 40 years. Even so, it can affect either gender and at any point in one's life.
Causes of CRPS
CRPS causes vary widely. To have a better understanding of this condition, you should get acquainted with the causes and circumstances that could contribute to its emergence:
Fractures
A traumatic injury to the leg or arm, including fractures may result in CRPS.
Surgery
It has been documented that CRPS can develop after a leg or arm has undergone a surgical operation or has had a section of it immobilized. It should be noted that surgical operations are hardly utilized to address the problem because it could make it worse.
Nerve Injuries
It is believed that injuries that result in faulty interactions between the peripheral and central nervous systems could be the origin of CRPS.
Burns and Cuts
CRPS often results from a severe injury, however, this is rarely the case. The condition could also be brought on by minor burns or cuts.
Limb Immobilization
CRPS is frequently brought on by limb immobilization.
Infections
Many different infections have the potential to evolve into CRPS Complex Regional Pain Syndrome. These can include herpes, TB, mycobacterium, chlamydia, among others.
Sprained Ankle
CRPS can be brought on by even a minor injury like sprained ankles. Although the exact explanation of this relationship is unknown, it could be related to the unusual response brought on by the ankle and foot being splinted or not utilized at all.
Poor Nerve Health
A pain response that results in CRPS may be brought on when the nerves are in poor health.
Signs and Symptoms of CRPS
The signs and symptoms of Complex regional pain syndrome may differ mildly from patient to patient based on phase one at that moment. Some patients may exhibit every one of the signs listed, while others may exhibit only some of them. Furthermore, based on how long the CRPS has been present, symptoms could change with time.
- Extreme pain characterized by burning, needles, pins, and/or squeezing or crushing sensations
- Skin color changes. The skin could turn blue, pink, purple, or red when particularly in comparison with the unaffected limb
- Alterations in the limb's hair or nail growth, including brittle nails or, based on the individual, enhanced or reduced hair growth
- Skin changes, becoming shinier and thinner
- Changes in sweating, such as excessive perspiration or less perspiration on one limb than the other
- Skin temperatures. Even though patients think their limb is burning, it feels cold when touched
- Decreased joint motion and increased stiff joints
- Enhanced muscle convulsions and stiffness in the limb
- Osteoporosis that could be shown on x-ray images
- Allodynia, which is an extreme sensitivity to standard skin touch
Patients may also suffer the following symptoms as the medical condition worsens and persists:
- Muscle atrophy in the limbs as a result of reduced usage
- Problems with short-term memory
- Difficulty finding words to say when talking
- Depression
- Irritability
- Increased limb swelling
- Sensitivity to vibration and noise
Besides that, studies have shown that patients in pain have trouble telling which limb is affected when depicted in a picture of that part of the body. Many people with CRPS experience the same problem, being incapable of telling whether a leg or hand is on the left or right while looking at an image.
Treatment of CRPS
Complex regional pain syndrome has no known cure, but a blend of physical therapies, medications, and mental support could assist in managing the symptoms. The pain and a number of the symptoms associated with CRPS are thought to gradually improve within the first two years for about 85% of patients. However, some patients continue to feel pain despite receiving treatment. In a few rare instances, other issues could arise, like muscular atrophy in the injured limb. Right now, it's impossible to forecast who will get better and when.
Your Course of Treatment
There are four main treatment strategies for CRPS:
- Self-management as well as education: recommendations for any measures you can undertake to help in managing the condition
- Physical therapy to enable you to function better and lower your risk of developing chronic physical issues
- Pain relief techniques to minimize your pain
- psychological assistance. These are treatments to assist you in coping with the psychological effects of having CRPS
Here is a description of some of the key CRPS treatments.
Education and Self-management
You will receive advice regarding self-care measures as a component of your treatment regimen to assist you to manage your disease. This could consist of:
- Education that will aid in your understanding of your condition
- Help to continue using the injured limb and staying active
- Learning strategies to assist you in coping when pain increases
- Finding ways to relax can help you live a better life
- Suggestions for management activities to help prevent peaks and declines in the activity regardless of the pain
- Using at-home rehabilitation procedures, such as desensitization methods
- Using the available local support networks
Physical Therapy
Multiple types of treatments are used in physical therapy. The goal is to progressively enhance your ability to perform tasks and engage in exercises without increasing the pain levels. This could be challenging because any motion or provocation of the affected limb will exacerbate pain as well as other CRPS symptoms like swelling, change in color, and perspiration. A therapist who has expertise in CRPS should assist your therapy because excessive or strenuous exercise might exacerbate the illness. The following techniques could be incorporated into your physical therapy regimen.
Exercises
The exercise program could involve a variety of mild activities, from easy stretching to weight-bearing or hydrotherapy exercises.
Desensitization
Desensitization is a method for lessening the hypersensitivity of CRPS-affected body parts. In most cases, it entails touching an uninjured body part next to the affected body part with fabrics of various textures, like wool or silk, and paying attention to how it feels.
After that, as you attempt to remember how it felt as the materials were touching the uninjured part of the body, the same fabrics are slowly placed on the injured limb. At first, this procedure will probably be unpleasant or painful, but over time, it might lessen the hypersensitivity in the afflicted body region, making it more like the unaffected regions.
Graded Motor Imagery and Mirror Visual Feedback
Movement could be challenging if you suffer from CRPS since the instructions the brain requires to carry out movements are either lacking or distorted. Treatments such as mirror visual feedback or graded motor imagery try to enhance movement by reprogramming a patient's brain for the lacking or distorted pieces of data.
Pain Relief
Several medications have the potential to treat CRPS. You can talk about them with your specialist doctor. The healthcare practitioner will first test less potent painkillers and only switch to stronger ones if needed.
Here are a few of the most common treatments for pain relief.
Non-steroidal Anti-Inflammatory Medications
The first medications frequently used to address CRPS are non-steroidal anti-inflammatory medications, for example, ibuprofen. Non-steroidal anti-inflammatory medications can help in lessening the pain brought on by the injuries that led to your condition. They could help relieve pains brought on by CRPS, like muscular pain within the shoulder whenever the condition affects the hand. However, it's unlikely that NSAIDs will lessen the pain caused by CRPS.
Anticonvulsants and Antidepressants
Anticonvulsants are typically used to manage epilepsy, but they can also be effective for alleviating nerve pain. The two anticonvulsants that are most frequently used to treat CRPS are pregabalin and gabapentin. Anticonvulsant medications often cause sleepiness, fatigue, and weight gain as adverse effects. Suicidal thoughts are also somewhat more likely to occur, and they could start as early as one week into the treatment. Anticonvulsant therapy should not be abruptly stopped since withdrawal symptoms could occur. Your doctor will organize for your dosage to be gradually decreased whenever you feel you do not have to use it anymore.
Similar to anticonvulsants, tricyclic antidepressants were shown to be beneficial in reducing nerve pain despite being initially developed to address depression. The most commonly used antidepressants for addressing CRPS are nortriptyline and amitriptyline, but nortriptyline often has lesser side effects. These medications, which frequently enhance sleep quality, are typically used in the early hours of the evening to lower the possibility of "hangover" symptoms the following morning.
The following are potential side effects:
- Dry mouth
- Constipation
- Blurred vision
- Difficulty urinating
- Heart palpitations
If you abruptly stop using TCAs, you can develop withdrawal symptoms. Your doctor will organize for your dosage to be gradually decreased over four weeks whenever you believe you do not have to use them anymore.
Opioids
Opioids like morphine and codeine, which can occasionally relieve severe pain, can help. Opiate medications frequently have these side effects:
- Nausea and vomiting
- Dry mouth
- Constipation
- Thought processes could be slowed (cognitive issues)
- Tiredness
Long-term opiate usage has been related to more significant health issues, for example, depression, irregular menstruation cycles in women, as well as erectile dysfunction in males. The perks of utilizing opioids could exceed the concerns in some cases, but these medications are generally not very fruitful in addressing CRPS.
Although there may be some exceptions in a handful of patients when taken under the guidance of a pain expert, long-term usage of large dosages is typically not encouraged.
Stimulation of the Spinal Cord
If taking medication does not make your pain go away, stimulation of the spinal cord could be suggested as a treatment. It entails having a gadget inserted beneath your stomach's or buttock's skin and connected to a lead positioned near your spinal nerves. The spinal cord receives gentle electrical pulses generated by the gadget. The pulses alter your perception of pain. Your pain could be covered up by a tingling feeling in the area of the body that mostly hurts. As your discomfort decreases or increases, the intensity of stimulation could be changed, and the gadget can be taken out if necessary.
Stimulation of the spinal cord can only be taken into account if:
- Six months after using various treatments, your pain has not subsided
- You have completed the stimulation trial; but, the leads were merely placed for the trial; they were not implanted
- If your medical team believes spinal cord stimulation would be beneficial, they will talk about it with you to discuss the best course of action
Psychological Assistance
Coping with a chronic pain condition could be frustrating, and those who have CRPS often struggle with psychological issues like depression and anxiety. Maintaining your psychological health is crucial since anxiety and depressive symptoms can hinder your recovery. You may benefit from psychological therapy if you want to learn how to manage your pain symptoms effectively.
For instance, some research has indicated that cognitive behavioral therapy (CBT) can aid in the treatment of chronic pain. In programs for pain management, such therapies are frequently given to small clusters of patients who are experiencing extreme pain along with rehabilitation methods. The goal of cognitive behavioral therapy is to make you more aware of the interconnectedness of your issues, emotions, feelings, and behavior.
CBT can assist you to deal with your condition and make it much simpler for you to proceed with your recovery program by talking about and changing how you perceive your condition.
The Healthcare Team
Since CRPS is such a complex condition, your treatment will typically involve a variety of medical specialists.
They could consist of:
- A physical therapist who can assist you in enhancing coordination and mobility
- A therapist who specializes in occupational therapy can assist you in enhancing the abilities required for daily operations
- A physician, a pain management specialist, or even another healthcare practitioner with training in pain management
- An expert in mental wellbeing, such as a psychologist, can assist in managing and understanding the emotional effects associated with chronic pain
- A social worker to advise and educate about additional services and assistance
- An employment advisor who can assist you as well as your employer remain in or getting back into the workforce by providing support and guidance
These medical providers could collaborate with you on managing pain programs individually or collectively. The goal is to assist you so that, even though the severity of your discomfort cannot be lessened, you will be able to control the effect of pain.
Complex regional pain syndrome is a severe, extremely painful syndrome that can be crippling. The best therapeutic options for preserving function and providing pain management are physiotherapy techniques. Combining other medical therapies for physical therapy to enhance function and reduce pain could make CRPS tolerable and even force it to enter remission. You can see a physician right away if you think you may have CRPS depending on the details provided above. Your chances of entering CRPS remission will be higher the earlier you receive a diagnosis.
Find a CRPS Treatment Facility Near Me
If you or your loved one has been affected by CRPS, you can contact Hollywood Healthcare & Diagnostic Imaging in Los Angeles to get answers to your questions. Call us today at 323-486-7502 to receive the help you need.
