Complex Regional Pain Syndrome (CRPS), also known as Reflex Sympathetic Dystrophy (RSD), is a Chronic Neurological Syndrome characterized by:
- Severe Burning Pain
- Extreme Sensitivity To Touch
1) The CONSTANT PAIN can be described as a burning pain.
It feels as if a red hot poker were inserted into the affected area. it is also described as throbbing, aching stabbing, sharp, tingling, and/or crushing in the effected area; this is not always the site of the trauma. The effected area is usually hot or cold to the touch. The pain will be more severe than anticipated for the type of injury sustained.
This is a hallmark of the disease. Allodynia is typically present as well. Allodynia is an extreme sensitivity to touch, sound, vibration, barometric pressure changes, loud noises, wind/breeze, temperature, clothing, and even the gentle touch of a loved one. This makes it increasingly difficult on the spouses, children, and other family members; as their softest touch can now cause pain instead of comfort. If the patient has not been properly diagnosed yet and these sensations not properly explained, these symptoms can cause extreme duress and confusion to all involved.
2) The INFLAMMATION is not always present in the same form but it can take various forms;
The skin may appear mottled, become easily bruised, bleeding in the skin, small red dots, have a shiny, dry, red, and “tight” look to it. In addition; increase in sweating usually occurs as well as swelling in and around the joints (shoulders, knees, wrists). In some patients a lack of sweating may occur, and some even go back and forth between the two.
3) The SPASMS result in a feeling of
A coldness in the effected extremity as well as body fatigue, skin rashes, low-grade fever, swelling (edema), sores, dystonia, and tremors.
The spasms can be confined to one area or be rolling in nature; moving up and down the leg, arm, or back.
They can involve not only muscles but also blood vessels.
4) The fourth part of this square is INSOMNIA and EMOTIONAL DISTURBANCE.
CRPS affects the limbic system of the brain. Doctor Hooshang Hooshmand described it well: “The fact that the sympathetic sensory nerve fibers carrying the sympathetic pain and impulse up to the brain terminate in the part of the brain called “limbic system”. This limbic (marginal) system which is positioned between the old brain (brainstem) and the new brain (cerebral hemispheres) is mainly located over the temporal and frontal lobes of the brain.” This causes many problems that might not initially be linked to a disease like CRPS; chief among them are depression, insomnia and short-term memory problems but also includes agitation, irritability, and possibly even poor judgement.
Other Symptoms That Can Be Involved:
–changes in skin temperature (warmer or cooler compared to the healthy/opposite limb).
– changes in skin color (skin may appear red, dusky, covered with red dots, cyanotic, blotchy, or pale).
– hypersensitivity to touch, sound, vibration, wind, noise, temperature, barometric pressure changes, water temperature, etc.
– depression, fatigue, and/or insomnia.
– changes in hair/nail growth (nails can become brittle, cracked, or grooved
– increased/decreased hair/nail growth).
– skin can become shiny, changes in sweating patterns
– bone and muscle loss/changes, atrophy/weakness.
– swelling and stiffness in effected joints.
– throbbing, crushing, tingling, shooting, aching, stabbing, burning pain in the effected area.
– tremors (shakes).
– problems moving the effected extremity/body part.
– migraines/cluster headaches.
There Are Two Types Of CRPS/RSD
– Type I and Type II
* CRPS Type I (also referred to as RSD)
– cases in which the nerve injury cannot be immediately identified
* CRPS Type II (also referred to as Causalgia)
– cases in which a distinct “major” nerve injury has occurred
* CRPS is best described in terms of an injury to a nerve or soft tissue (e.g. broken bone) that does not follow the normal healing path
* CRPS development does not appear to depend on the magnitude of the injury. The sympathetic nervous system seems to assume an abnormal function after an injury.
* Since there is no single laboratory test to diagnose CRPS, the physician must assess and document both subjective complaints (medical history) and, if present, objective findings (physical examination).
Criteria for Diagnosing Complex Regional Pain Syndrome Type I (RSD)
* The presence of an initiating noxious event, or a cause of immobilization
* Continuing pain, allodynia, or hyperalgesia with which the pain is disproportionate to any inciting event
* Evidence at some time of edema, changes in skin blood flow (skin color changes, skin temperature changes more than 1.1°C difference from the homologous body part), or abnormal sudomotor activity in the region of the pain
* This diagnosis is excluded by the existence of conditions that would otherwise account for the degree of pain and dysfunction
Complex Regional Pain Syndrome Type II (Causalgia)
* The presence of continuing pain, allodynia, or hyperalgesia after a nerve injury, not necessarily limited to the distribution of the injured nerve
* Evidence at some time of edema, changes in skin blood flow (skin color changes, skin temperature changes more than 1.1°C difference from the homologous body part), or abnormal sudomotor activity in the region of pain
* This diagnosis is excluded by the existence of conditions that would otherwise account for the degree of pain and dysfunction.