Complex Regional Pain Syndrome

Defining Complex Regional Pain Syndrome

Complex Regional Pain Syndrome (CRPS), formerly known as Reflex Sympathetic Dystrophy (RSD) or causalgia, is a chronic pain condition that typically affects one limb, usually after an injury or trauma. 

However, in some cases, it can also occur without any apparent injury. CRPS is believed to involve dysfunction in the central or peripheral nervous system.

The symptoms of CRPS can vary in severity and may include:

• Persistent, Severe Pain. The pain experienced with CRPS is often described as burning, stabbing, throbbing, or shooting.
• Changes in Skin Temperature and Colour. The affected limb may feel warmer or cooler than the surrounding areas, and the skin may appear red, blue, or blotchy.
• Swelling and Stiffness. The affected limb may swell, and there may be changes in the texture and thickness of the skin.
• Changes in Skin Texture. The skin on the affected limb may become shiny, thin, dry or excessively sweaty.
• Changes in Nail and Hair Growth. Nails may grow faster or slower, and there may be changes in hair growth patterns on the affected limb.
• Motor Dysfunction. CRPS can cause weakness, tremors, muscle spasms, and difficulty coordinating movements in the affected limb.

Why Does Complex Regional Pain Syndrome Occur?

CRPS is believed to result from a malfunction in the nervous system, both central and peripheral. However, the exact cause of Complex Regional Pain Syndrome is not fully understood, and it can be challenging to diagnose.

There is no single diagnostic test for CRPS, so diagnosis is typically based on a combination of medical history, physical examination, and ruling out other possible causes of the symptoms.

The formal diagnosis of Complex regional pain syndrome is achieved by fulfilling the Budapest Criteria for CRPS.

Patients must demonstrate:

1. Continuing pain, which is disproportionate to any inciting event

2. Must report at least one symptom in three of the four following categories:

• Sensory: reports of hyperaesthesia (heightened pain sensitivity) and/or allodynia (pain in situations that are not normally painful such as touch, temperature or movement). Allodynia (pain in situations that are not normally 
• Vasomotor: reports of temperature asymmetry (greater than 1C) and/or skin colour changes and/or skin colour asymmetry
• Sudomotor/Oedema: reports of oedema and/or sweating changes and/or sweating asymmetry
• Motor/Trophic: reports of decreased range of motion and/or motor dysfunction (weakness, tremor, dystonia) and/or trophic changes (hair, nail, skin)

3. Must display at least one sign at time of evaluation in two or more of the following categories:

• Sensory: evidence of hyperalgesia (to pinprick) and/or allodynia (to light touch and/or deep somatic pressure and/or joint movement)
• Vasomotor: evidence of temperature asymmetry and/or skin colour changes and/or asymmetry
• Sudomotor/Oedema: evidence of oedema and/or sweating changes and/or sweating asymmetry
• Motor/Trophic: evidence of decreased range of motion and/or motor dysfunction (weakness, tremor, dystonia) and/or trophic changes (hair, nail, skin)

4. There is no other diagnosis that better explains the signs and symptoms.

Dr Mittal may conduct a variety of diagnostic tests such as MRIs, X-rays and nerve conduction studies to ensure there is no other diagnosis that explains the symptoms and signs above. 

What Causes Complex Regional Pain Syndrome?

Complex Regional Pain Syndrome can develop for various reasons, and it is not fully understood. It is generally believed to involve dysfunction in the central or peripheral nervous system, particularly the autonomic nervous system, which controls involuntary bodily functions like blood flow, temperature regulation, and sweating. 

Here are some factors that may contribute to the development of CRPS:

• Injury or Trauma. CRPS often occurs following an injury or trauma, such as a fracture, surgery, sprain, or soft tissue injury. However, not everyone who experiences an injury will develop CRPS. Similarly, in some cases, CRPS can be spontaneous without a history of trauma or injury.
• Nerve Damage. CRPS may result from damage to nerves, whether due to injury, surgery, infection, or another cause. This nerve damage can lead to abnormal signalling in the nervous system, causing pain and other symptoms associated with CRPS.
• Inflammatory Response. Inflammation is believed to play a role in CRPS. Following an injury, the body’s inflammatory response may become dysregulated, leading to excessive inflammation and sensitisation of nerves, which can contribute to the development of CRPS symptoms.
• Immune mechanisms. There are immune mechanisms that may contribute to the development of CRPS but more research is required to further identify these factors.
• Abnormal Healing Process. In some cases, the healing process following an injury may not proceed as expected, leading to abnormal tissue repair and changes in the affected limb. These changes can contribute to the development of CRPS symptoms.
• Genetic Predisposition. There may be a genetic component to CRPS, as it tends to occur more frequently in individuals with a family history of the condition or other chronic pain disorders.
• Psychological Factors. Psychological factors, such as stress, anxiety, and depression, can influence the perception of pain and may exacerbate CRPS symptoms. Additionally, living with chronic pain can have a significant impact on a person’s mental health and overall well-being.

It’s important to note that while these factors may contribute to the development of CRPS, the condition can vary widely from person to person, and the exact cause may be different for each individual. Additionally, not all cases of CRPS can be linked to a specific cause or trigger.

What is a Complex Regional Pain Syndrome Specialist?

A Complex Regional Pain Syndrome (CRPS) specialist is a medical professional with expertise in diagnosing and treating CRPS, a complex chronic pain condition. 

Multidisciplinary Teams for Complex Regional Pain Syndrome Management

The types of doctors that treat CRPS often include pain management physicians, neurologists, physiotherapists and rehabilitation specialists who have undergone additional training and experience in managing the complexities of CRPS and providing comprehensive care tailored to the individual needs of patients.

What Does a Pain Management Plan for Complex Regional Pain Syndrome Involve?

A treatment plan for Complex Regional Pain Syndrome (CRPS) is typically devised by a pain management specialist who has expertise in this field. 

It generally involves a multidisciplinary approach aimed at managing pain, improving function, and enhancing your general well-being. It is important that CRPS is diagnosed and managed early to improve prognostic outcomes.

A delay in the diagnosis and treatment of CRPS can have a devastating impact on the long term status of the condition. 

This plan may include:

• Medications. Prescription medications such as pain relievers, anti-inflammatories, antidepressants, anticonvulsants, muscle relaxants and topical therapy may be used to alleviate pain, improve sleep, and manage other symptoms associated with CRPS.
• Physical Therapy. Physical therapy plays a crucial role in CRPS treatment by focusing on restoring mobility, strength, flexibility, and function in the affected limb. Therapeutic exercises, manual therapy, desensitisation techniques, and modalities like heat, cold, and electrical stimulation may be utilised. Physiotherapists must have an expertise in managing the condition with training in CRPS targeted physiotherapy which includes left-right orientation, graded motor imagery and mirror therapy.
• Occupational Therapy: Occupational therapy helps patients learn adaptive strategies to perform daily activities despite pain and limitations caused by CRPS. Therapists may provide education on joint protection, energy conservation, and assistive devices to improve independence and quality of life.
• Sympathetic Nerve Blocks. Sympathetic nerve blocks involve injecting an anaesthetic agent near the sympathetic nerves to temporarily block pain signals and improve blood flow to the affected limb. These blocks may provide short-term relief and help identify whether sympathetic nervous system dysfunction contributes to the patient’s symptoms.
• Spinal Cord Stimulation (SCS). SCS involves implanting a device that delivers electrical impulses to the spinal cord to disrupt pain signals and alleviate CRPS-related pain. SCS may be considered for patients who have not responded to other treatments or who experience severe, refractory pain.
• Psychological Support. Managing the psychological impact of CRPS is essential, as the condition can significantly affect mood, stress levels, and overall well-being. Cognitive-behavioural therapy (CBT), relaxation techniques, biofeedback, and counselling may be beneficial in helping patients cope with pain and improve emotional resilience.
• Medication Management. Close monitoring and adjustment of medications are often necessary to optimise pain control while minimising side effects and risks associated with long-term medication use.
• Lifestyle Modifications. Encouraging healthy lifestyle habits, such as maintaining a balanced diet, engaging in regular exercise within the limits of pain tolerance, practising stress-reduction techniques, and avoiding smoking and excessive alcohol consumption, can support overall well-being and symptom management.
• Continued Monitoring and Follow-Ups. CRPS is a chronic condition that may require ongoing management and adjustments to the treatment plan based on the patient’s response and changing needs. Regular follow-up appointments with healthcare providers are essential to assess progress, address concerns, and make necessary modifications to the treatment approach.

The Challenges of Living With Complex Regional Pain Syndrome

Living with Complex Regional Pain Syndrome presents numerous challenges that can significantly impact your physical, emotional, and social well-being. 

Some of these challenges include:

• Chronic Pain. CRPS is characterised by persistent, severe pain that can be debilitating and resistant to treatment. The pain may fluctuate in intensity and may not respond well to conventional pain management strategies, making it difficult to find effective relief.
• Physical Limitations. CRPS can cause a range of physical limitations, including decreased mobility, weakness, muscle atrophy, stiffness, and difficulty performing daily activities. These limitations can affect independence, productivity, and quality of life.
• Psychological Distress. Living with chronic pain can lead to significant psychological distress, including anxiety, depression, frustration, and irritability. The constant struggle with pain and its impact on daily life can take a toll on mental health and overall well-being.
• Sleep Disturbances. Persistent pain and discomfort associated with CRPS can disrupt sleep patterns, leading to insomnia, fatigue, and daytime drowsiness. Poor sleep quality can exacerbate pain sensitivity and contribute to emotional and cognitive difficulties.
• Social Isolation. The physical limitations and unpredictable nature of CRPS can result in social withdrawal and isolation. Individuals may avoid social activities, work, and social gatherings due to fear of exacerbating pain or feeling misunderstood by others.
• Financial Strain. Managing CRPS often requires ongoing medical care, rehabilitation therapies, medications, and assistive devices, which can lead to financial strain, especially if the condition affects your ability to work and earn income.
• Stigma and Misunderstanding. CRPS is a complex and poorly understood condition, which can lead to stigma, scepticism, and misunderstanding from healthcare providers, employers, family members, and friends. This lack of awareness may delay diagnosis, hinder access to appropriate treatment, and contribute to feelings of isolation and frustration.
• Uncertainty and Frustration. The unpredictable nature of CRPS, combined with the lack of a cure and variable treatment outcomes, can create feelings of uncertainty, frustration, and hopelessness. Coping with the challenges of CRPS requires resilience, patience, and perseverance.
• Impact on Relationships. CRPS can strain relationships with family members, friends, and romantic partners, as individuals may struggle to communicate their pain experiences, manage caregiving responsibilities, and maintain social connections amidst the challenges of the condition.
• Loss of Identity and Role Changes. Adjusting to life with CRPS may involve significant changes in roles, identity, and self-concept. You may need to adapt to new physical limitations, career changes, and lifestyle modifications, which can affect self-esteem and sense of purpose.

Overall, living with CRPS requires a holistic approach to management that addresses the physical, emotional, and social aspects of the condition, along with ongoing support from healthcare providers, loved ones, and peer support groups.

How do I Find a Complex Regional Pain Syndrome Specialist Near Me?

To find a CRPS  specialist in or around Melbourne, you can start by asking your general practitioner for referrals to a pain specialist, ideally one with a team or network of pain management professionals who have experience treating Complex Regional Pain Syndrome. 

Seeking out doctors with the right credentials and experience is also a good first step towards finding a pain management specialist in your location.

You can also consider asking friends, family, and even support groups for CRPS (both online or in-person) for referrals to physicians they’ve found valuable. 

Persistent Pain Solutions for Complex Regional Pain Syndrome

Dr Mittal and her collaborative multidisciplinary team of healthcare professionals work to provide compassionate care to every chronic pain patient who walks through their doors. 

Complex Regional Pain Syndrome or other chronic pain takes a deep physical and emotional toll on individuals — and their friends and family.

The Persistent Pain Solutions clinic offers a healing atmosphere where your concerns are heard and your needs are valued. Dr Mittal prides herself on prioritising empathy, understanding, and support. 

Compassion is essential to healing, after all, and Dr Mittal is dedicated to guiding you on your path to relief from Complex Regional Pain Syndrome and restoring your ability to enjoy your daily routine and live a healthier, and more comfortable life.