A Fact Sheet- Complex Regional Pain Syndrome
The Complex regional pain syndrome (CRPS) is an unceasing pain condition that often affects one of the limbs (that can be arms, legs, hands, or feet), generally after an injury or trauma to that particular limb. Complex regional pain syndrome is believed to be caused due to damage, or malfunctioning of the peripheral and central nervous systems. The central nervous system encompasses the brain and spinal cord; whereas the peripheral nervous system includes the nerve signaling from the brain and the spinal cord to the other parts of the body. The Complex Regional Pain Syndrome is exemplified by prolonged or a chronic pain and mild or dramatic changes in the color of the skin, temperature or even swelling in the affecting area.
There are the two similar forms of the Complex regional pain syndrome, generally called CRPS- I and CRPS-II, having similar symptoms and treatments. The CRPS-II was previously called causalgia; it is also the term which is used for patients with corroborated nerve injuries. People without the confirmation of the nerve injury are classified under the category of CRPS-I, to validate and investigate the two different forms of the Complex regional pain syndrome.
The symptom of the complex regional pain syndrome differs in sternness and duration. According to the studies of the occurrence and prevalence of the disorder, it is observed that in most cases the symptoms are mild and individual recovers gradually over a period of time. In some cases, the individuals may not be able to recover and may undergo a long-term disability.
What causes CRPS?
Doctors are not sure what causes the individuals to develop complex regional pain syndrome, while others with similar sufferings does not. Observed, that more than 90% of cases, the conditions are activated by a clear history of trauma or injury. The complex regional pain syndrome generally characterizes abnormal response that amplifies the effects of the injury. Some people may respond to a trigger immediately, whereas to some it causes no such problem.
The peripheral nerve abnormalities are found in individuals with complex regional pain syndrome generally involves the small un-myelinated and myelinated nerve fibers i.e. axons, that are responsible in carrying the pain messages and signals to blood vessels. This is because the small fibers in the nerves commune with blood vessels, small nerve fibers injuries that may trigger other different symptoms of complex regional pain syndrome. The molecule secreted from these hyperactive injured nerve fibers are thought to add abnormalities to the inflammation and the blood vessels. These abnormalities in the peripheral nerve in turn triggers the abnormal neurological function in the spinal cord and brain which leads in some cases to complex disorders of higher cortical function.
Please note: Myelin is a fusion of proteins and fat- like substances that are surrounded and insulated by few nerve fibres.
Another abnormality in CRPS/ RSD (Reflex Sympathetic Dystrophy) may cause the blood vessels to dilate or leak fluid into the adjacent tissue, resulting in red, swollen skin. The core muscles and deeper tissues may become starved of the oxygen and the nutrients, causing the muscles to damage. In some cases the blood vessels may clamp down, causing cold, white or blue colored skin. The dilation and constriction of the blood vessels is controlled by axons as well as the chemical messengers in the blood.
The complex regional pain syndrome may also affect your immune system. The increased levels of inflammatory cytokines have been found in the tissues of the individuals with this disorder. it also contributes redness, swelling and warmth, as reported by many patients with complex regional pain syndrome. It is more common in people with other inflammatory and autoimmune conditions such as asthma.
Only some Studies claim that complex regional pain syndrome may also be influenced genetically. The familial CRPS and RSD may be sterner with the earlier onset, greater dystonia and may affect more than one limb.
Sporadically, Complex Regional Pain Syndrome grows without any known injury. There might be an internal injury caused by an contagion, a blood vessel hindrance, or entrapment of the nerves, so careful examination is recommended in order to determine the cause and to treat it.
In several cases, Complex Regional Pain Syndrome is the result of various causes that act together to produce a variety of symptoms.
What is the prognosis?
The result of Complex regional pain syndrome differs from one person to another. Nearly all children or teens tends have well recovery. Some individuals are sometimes left with assiduous pain and crippling, irreparable changes despite treatment. Subjective evidence suggests the early treatment, predominantly rehabilitation, is helpful in off-putting the disorder, but this benefit has not yet been proven in quantifiable studies. More research is indeed required to understand the causes of CRPS/ RSD, how it develops, and the role of early treatment.
How is CRPS Treated? Various Treatments & Therapies
The following therapies are often used to treat complex regional pain syndrome:
The Rehabilitation Therapy
It is an exercise program which helps to keep the painful limb or body part moving in order to improve the blood circulation and reduce the other circulatory symptoms. In addition to this, exercise can help to improve the flexibility, strength and function of the affected limb or body part moving in order to improve the blood circulation and reduce the other circulatory symptoms. Rehabilitating, the affected limb may also help to prevent or reverse the secondary brain changes that are allied with chronic pain. The Occupational therapy can help the individual to learn new ways to work and perform daily chores.
Complex regional pain syndrome and other painful and hindering conditions usually are associated with reflective psychological symptoms for the ones affected, along with their families. People with Complex regional pain syndrome may undergo depression, anxiety, or post-traumatic stress disorder, all of which an intensified observation of pain and makes the rehabilitation efforts more difficult. Treating these secondary situations is important for helping people to cope and recover from complex regional pain syndrome.
Numerous diverse classes of medication have been shown to be effective for complex regional pain syndrome, chiefly when used early in the course of the disorder. No such drug is approved by the U.S. Food and Drug Administration for complex regional pain syndrome. There is not a single drug or blend of drugs is guaranteed to be effective in every person. Drugs to treat complex regional pain syndrome include:
- The non-steroidal, anti-inflammatory drugs to treat temperate pain, counting over-the-counter aspirin, ibuprofen, and naproxin
- Corticosteroids that helps in the treatment of inflammation/swelling and edema, such as prednisolone and methylprednisolone (used mostly in the untimely stages of CRPS)
- The drugs developed initially to treat abductions or depression but now shown to be effectual for neuropathic pain, such as gabapentin, pregabalin, amitriptyline, nortriptyline, and duloxetine
- botulinum toxin vaccinations
- opioids such as oxycontin, morphine, hydrocodone, fentanyl, and vicodin
- N-methyl-D-aspartate (NMDA) receptor opponents such as dextromethorphan and ketamine
- The nasal calcitonin, especially for deep bone pain, and
- Topical local sedative creams and patches such as lidocaine.
All drugs or combination of drugs can cause a number of side effects such as drowsiness, dizziness, increased heartbeat, and blighted memory.
Sympathetic nerve block
Some individuals report fleeting pain relief from the sympathetic nerve blockades, but there is no such evidence of long-term advantage. Sympathetic blocks involve vaccinations, an anesthetic next to the spine in order to directly block the bustle of sympathetic nerves and improve blood circulation.
The use of this procedure that obliterates some of the nerves is divisive. Some of the experts may think that it is unjustifiable and makes the complex regional pain syndrome worse; others report a positive outcome. Sympathectomy should be used only in individuals whose pain is radically relieved (temporarily) by the sympathetic nerve blocks. It also can reduce surfeit sweating.
Spinal cord stimulation
Introducing the stimulating electrodes all the way through a needle into the spine near the spinal cord provides a tingling feeling in the painful area. Characteristically the electrode is placed momentarily for a few days to evaluate whether the stimulation will be helpful. Minor surgery is also required to establish all the parts under the skin on the torso. Once implanted, the stimulator can be turned on and off accordingly, and attuned using an external manager.
Intrathecal drug pumps
These devices impel the pain-relieving medications directly into the fluids that cleanse the spinal cord, on an average opioids and local anesthetic agents such as clonidine and baclofen. The benefit of the pain-signaling agents in the spinal cord can be reached using the amount doses far lower than those required for the oral admin, which decreases the side effects and increases drug effectiveness.
Budding treatments for CRPS include:
Various researchers are using the low doses of ketamine—a strong anesthetic— often given intravenously regularly for several days in order to reduce considerably or to abolish the chronic pain of complex regional pain syndrome. In many clinical testing, ketamine has been made known to be helpful- treating pain that does not respond well to other treatments.
- Hyperbaric oxygen
More than a few studies have scrutinized the use of hyperbaric oxygen therapy for chronic pain. Individuals are made to lie down in a tank that contains pressurized air, which then delivers more oxygen to the organ and tissue body. Even though research is still under research, some researchers has reported that hyperbaric oxygen can help in the reduction of swelling and pain, and recover the range of motion in individuals with complex regional pain syndrome.
Numerous alternative therapies are being utilized in order to treat the painful conditions. The options involve behavior modification, acupuncture, relaxation techniques and the chiropractic treatment.
What research is currently being done on CRPS?
The complex regional pain syndrome can be treated using a scrambler therapy also known as Calmare, according to the research presented at the American Academy of Physical medicine and Rehabilitation Annual Assembly. The researchers have introduced scrambler therapy called Calmare as a noninvasive neuro modulation approach in the treatment of chronic neuropathic pain. The Calmare is thought to meddle with the pain neuromatrix pain by providing non-pain codes. Although the therapy was originally developed to treat pain in cancer-related neuropathic pain and chemotherapy induced in peripheral neuropathy patients. However, it has not been widely examined for the pediatric patients, which the researchers aimed to rectify in their researches presently.
However, it has not been widely tested for pediatric patients, which the researchers aimed to rectify in their current research. “While estimating, the multidisciplinary concerned model best fits the healing model for this diverse patient group, by allowing the flexibility for each individual patient along with their needs while heartening peer, family, and team prop up, with the goal of sustained enduring progress and revival,” which resolute children with unceasing neuropathic pain counter better to noninvasive approaches to pain organization.
By identifying the nervous system as a cybernetic system that retorts to nerve pain as coded information, examiners were able to pinpoint when persistent pain receptors have been damaged. They noticed it created flawed codes that were autonomous from the pain source. The researchers noticed the pain signals reinterpreted by the brain; or else, the signals were ongoing to be interpreted as pain signals back to the body. Calmare was used to seize these pain signals and send non- pain signals back to the brain of the individual. Calmare completely impacted the attempt to decrease the various forms of neuropathic pain. In a case study, the researchers accomplished the ST Calmare pain therapy was appropriate for the treatment of the complex regional pain syndrome.