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Complex Regional Pain Syndrome (CRPS or RSD)

Discussion in 'If You’re In Pain…' started by Josephine, Aug 11, 2017.

  1. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator
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    I did quite a bit of research on CRPS (complex regional pain syndrome) at one time.
    #CRPS

    What happens is that normally when nerves are stimulated by a pain somewhere, they fire like an electric spark that shoots up the nerve cell (called a neurone) and travels from one cell to another. As each cell fires, it's supposed to go into a short period of rest before it can fire again. But when the leg is affected by CRPS, the nerve cells are just randomly and constantly firing which is why pain meds and all the other usual remedies just won't work.

    neurones.JPG

    There are some do's and don'ts with this - first be very careful of movement or any other stimulation like massage. A CPM is not a good idea as it will keep the nerves firing. Neither is ice or heat. Even hot water from a shower can do it. Rest is your best friend right now. You have to try and figure out for yourself what triggers an attack and then avoid it.

    Good news is that CRPS can go into remission if it's allowed to (no CPM!) but bad news is that almost anything can start it off again. You could go into a remission and do certain things a dozen times and then suddenly one day it will set it off again. Some people (lucky ones) just have the one episode and that's it. It can be caused by anything from a broken ankle to several extensive surgeries, from a bad fall to aggressive massage/PT. In truth, as yet this is a poorly understood phenomenon and the best that is known as that there is still a lot to be learned. Every case is individual and has it's own course and manifestations so there is no 'textbook' case to tell you about. I truly wish there was.
     
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  2. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator
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    Complex regional pain syndrome (CRPS) is a poorly understood condition in which a person develops a persistent (chronic) burning pain in one of their limbs.

    The pain usually develops after an injury – which in most cases is a minor injury – but the pain experienced is out of all proportion to what you would normally expect. For example, a person with CRPS may only strain their ankle but it can feel like a serious burn. The skin of the affected body part can become very sensitive, and even the slightest touch, bump, or change in temperature can provoke a feeling of intense pain. If left untreated the pain can spread to other parts of the body too.

    In some cases of CRPS the pain passes after a few weeks. In others it can persist for months or even years. Some people have repeated episodes of pain followed by long stretches of remission (being pain-free).

    Treating CRPS
    There are three main treatment approaches for CRPS which are used in combination:
    • physical therapy, such as physiotherapy, to help improve the range of movement in the affected body part and prevent muscle wasting
    • medication, such as the non-steroidal anti-inflammatory drugs (NSAIDs) type of painkillers such as ibuprofen, to relieve pain
    • Gabapentin is an anti-epileptic medication, also called an anticonvulsant. It affects chemicals and nerves in the body that are involved in the cause of seizures and some types of pain. Also use to treat to treat nerve pain caused by herpes virus or shingles, restless legs syndrome, neuropathy and sometimes CRPS. Pregablin (Lyrica) is an alternative medication in the same group.
    • counselling and support to help people cope better emotionally with the impact of living with chronic pain
    The sooner treatment is started after symptoms begin, the more effective it will be.

    What causes CRPS
    The cause of CRPS is unknown but the condition appears linked to an abnormal neural (involving the nervous system) response to injury. It appears something (nobody is sure what) causes certain nerves to misfire in some way triggering pain.

    CRPS could be the result of interconnected factors.
    A previous theory that CRPS was a psychosomatic condition (the symptoms of pain were psychological – "all in the mind") has been disproved because research shows people with CRPS undergo very real physical changes in their nervous system.

    Who is affected
    It is hard to estimate exactly how common CRPS is as many cases may go undiagnosed or misdiagnosed. One study reported as many as 1 in 3,800 people in England may be affected by CRPS. CRPS can begin at any age, though the average age for symptoms to start is around 40. Three out of four cases occur in women.

    Causes of complex regional pain syndrome
    Even though complex regional pain syndrome (CRPS) has been a recognised medical condition for more than 150 years, its exact cause is still unclear. The condition is usually triggered by an injury or trauma (damage to the body’s tissues).

    For example:
    • A tissue injury with no significant nerve damage, such as a sprained ankle, can lead to type one CRPS (triggered by a minor injury).
    • A peripheral nerve injury (when a nerve in one of your limbs is damaged), such as a broken arm, can lead to type two CRPS (triggered by a more serious injury).
    Why CRPS develops as a result of these injuries is still unknown. Due to the complex nature of the symptoms, most experts believe it is unlikely the condition has a single cause, and is probably caused by a combination of related factors.

    Some experts believe CRPS shouldn't be regarded as a single medical condition as there could be different conditions that all cause the same symptoms. Some of the theories about the causes of CRPS are described below.

    Sympathetic nervous system malfunction
    Another theory is that CRPS is associated with a malfunction in the sympathetic nervous system. The sympathetic nervous system is the part of the nervous system responsible for triggering your "fight or flight" reflex. This is a series of physical changes that your body undergoes when faced with a stressful or dangerous situation. For example, if you were suddenly confronted by a vicious dog, your sympathetic nervous system would increase your:
    • heart rate
    • breathing rate
    • blood pressure
    • levels of certain hormones, such as adrenalin (a stress hormone)
    This gives you a short-term release of energy, which can be helpful in either confronting or avoiding potential danger. This theory suggests that an initial physical injury may cause your sympathetic nervous system to release hormones your body usually releases during stressful situations, as part of the "fight or flight reflex" explained above. It is thought these hormones then activate pain receptors, which transmit pain signals to your brain.

    This may explain why people with CRPS often experience post-injury pain that is out of all proportion to the initial injury. It is not the injury itself causing the problem, but your body's abnormal response to it. As the sympathetic nervous system also helps regulate blood vessels in your skin, a malfunction of this system may also account for other associated symptoms of CRPS, such as changes in skin colour and temperature.

    Diagnosing complex regional pain syndrome
    There is no single test for complex regional pain syndrome (CRPS). It is usually diagnosed by ruling out other conditions that have similar symptoms.

    Tests
    Possible tests used to rule out other conditions are:
    • blood tests to rule out an underlying infection or rheumatoid arthritis
    • a magnetic resonance imaging (MRI) scan to rule out underlying problems with your tissue or bones
    • a biopsy, where a small tissue sample is removed and checked for the presence of abnormal cells
    • an xray to rule out problems with the joints and bones
    Tests that give a good indication that you have developed CRPS (although they can't confirm it) are described below.
    • A physical examination, where your GP or another specialist will check for physical signs of CRPS, such as swollen joints and changes to your skin’s temperature and appearance.
    • Sweat testing, where the sweat produced by both your affected limb and an unaffected limb is measured. A large difference between the two readings could indicate CRPS.
    • Thermography, where an infrared thermometer is used to measure your skin temperature at different parts of your body. If your affected limb has a much higher, or lower, skin temperature than the rest of your body, it could indicate CRPS.
    • Electrodiagnostic testing, where wires are attached to your skin to measure the electrical activity of your nerves. Abnormal readings may suggest that your nerves are damaged, and that you have type two CRPS.
    Diagnostic checklist
    As CRPS can be difficult to diagnose, experts have created a checklist to assist GPs and other healthcare professionals when making a diagnosis.

    A diagnosis of CRPS can be made if the following signs and symptoms are present:
    • You have recently experienced an injury or other type of trauma.
    • You have ongoing pain in a limb disproportionate to the original injury or trauma.
    • There is physical evidence of swelling, and changes to your skin temperature and appearance.
    • No other diagnosis would better explain your signs and symptoms.
    Referral
    If you are diagnosed with CRPS, you may be urgently referred to a specialist pain clinic. There are around 300 pain clinics in the UK, mostly within hospitals. There is also a national centre for CRPS based at the Royal National Hospital for Rheumatic Diseases in Bath. You may be advised to visit the centre once your diagnosis is confirmed so that a treatment plan can be drawn up. An urgent referral ensures treatment can be started immediately, because the earlier treatment is started, the less likely it is that you'll have any long-term disability.

    Treating complex regional pain syndrome
    The treatment of complex regional pain syndrome (CRPS) usually involves a combination of physical treatment methods and medication to manage pain. Helping you cope better with the emotional impact of living with pain is also an important part of treatment.

    Due to the complex nature of CRPS, treatment is usually provided by a team of different professionals working together.

    Members of your care team may include:
    • a physiotherapist – who will help you to improve your range of movement and coordination
    • an occupational therapist – who will help you improve skills needed for daily activities
    • a neurologist – a doctor who specialises in the treatment of conditions that affect the nervous system (the nerves, brain and spinal cord)
    • a psychologist – a specially trained mental health professional who can help with any associated psychological (mental) problems caused by living with a chronic (long-term), painful condition
    • a social worker – who will be able to provide information and advice about what extra help and services are available
    • a pain relief specialist – a doctor or other healthcare professional trained in pain relief

    Please read for more detail
    LINK 1
    LINK 2
    LINK 3
    LINK 4
    Posted with thanks to NHS Choices

    #CRPS
     
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