Complex Regional Pain Syndrome (CRPS)

Symptoms of CRPS

CRPS symptoms typically appear about one month after an injury to the affected limb. The most common symptom is pain that is significantly more intense than what is expected from the injury. This pain can be experienced as:

• Stinging

• Burning

• Stabbing

• Tearing

• Squeezing

Phases of CRPS

CRPS symptoms can occur in two distinct phases:

• Acute Phase (Warm Phase)

  • Pain worsens with movement.

  • Inflammation symptoms such as swelling, warmth, and redness are present.

• Chronic Phase (Cold Phase)

  • Begins about six months after the injury.

  • Persistent pain, often harder to alleviate.

  • Symptoms may include a grayish or bluish appearance of the skin, coldness and clamminess, skin texture changes, changes in hair and nail growth, muscle tremors or spasms, and osteoporosis affecting nearby bones.

Causes of CRPS

CRPS can be triggered by various injuries or activities, including:

• Bone fractures

• Sprains or strains

• Burns

• Cuts

• Penetration injuries

• Limb immobilization (e.g., casting)

• Surgery

Type 1 CRPS occurs without a specific nerve injury, while Type 2 CRPS is linked to a known nerve injury. More than 90% of CRPS cases result from an injury that damages tiny nerve fibers in the affected limb. These fibers lack a protective myelin sheath, making them more susceptible to damage. The exact reason why some individuals develop CRPS while others do not is still unclear, but factors such as neurological, immune, and genetic factors are likely involved.

Treatment for CRPS

There is no single treatment for CRPS; instead, treatment aims to alleviate symptoms and restore function to the affected limb. Treatment options may include:

• Physical Therapy : Exercises to improve strength, flexibility, and range of motion; mirror visual feedback and graded motor imagery to retrain the brain; desensitization to reduce limb sensitivity.

• Occupational Therapy: Strategies for better using the affected limb in daily activities.

• Neuropathic Pain Medications:Drugs like gabapentin, pregabalin, amitriptyline, and nortriptyline to ease nerve pain.

• Anti-inflammatory Medications:Nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroids to reduce inflammation.

• Bisphosphonates:Medications to reduce bone changes associated with CRPS.

• Psychotherapy:Support for managing anxiety, depression, or other mental and emotional strains caused by living with CRPS.

• Nerve Stimulation:Devices to send electrical signals to affected nerves, including spinal cord or peripheral nerve stimulation.

Risk Factors for CRPS

Certain factors may increase the risk of developing CRPS after an injury:

• Sex : CRPS is more common in individuals assigned female at birth.

• Age :Most commonly diagnosed around age 40.

• Injury Location: Injuries to the hand or arm are more commonly associated with CRPS.

• Type of Injury:Fractures and high-impact injuries increase the risk.

• Other Disorders:Medications to reduce bone changes associated with CRPS.

• Psychotherapy:A history of psychiatric disorders, headache disorders, or substance use disorder may be associated with an increased risk.

The Takeaway

CRPS is characterized by prolonged, excessive pain in a limb following an injury, due to nerve damage. Symptoms can gradually improve over months or years, but the condition can have a long-term impact if severe. Early treatment is crucial for a better prognosis. If you experience persistent, intense pain following a limb injury, it is important to seek medical evaluation and treatment.