Download Information leafletComplex regional pain syndrome (CRPS)
What is it?
CRPS is a painful condition of the limb usually after an injury and with associated swelling, altered sensations, skin colour changes, altered temperature and sweating. It usually affects the arm and leg, but has the ability to affect other parts of your body. The pain is out of proportion to the severity of the injury and will last much longer than would normally be expected.
CRPS is a well known but unpredictable complication of any upper limb surgery.
Is it called by any other name?
Reflex Sympathetic Dystrophy (RSD), Causalgia, Sudeck’s dystrophy
What is its cause?
CRPS is a complex and poorly understood condition of which the exact cause is still unknown. One of the theories is that the autonomic (sympathetic) nervous system starts to malfunction and sustains pain. The sympathetic nervous system is responsible our ‘fight-or-flight’ response. It activates our breathing, blood flow and other bodily processes that prepare us for fast paced action.
Another theory is that the syndrome maybe due to an abnormally triggered immune response, which leads to the characteristic inflammatory symptoms of redness, warmth, and swelling in the affected area.
The syndrome is called ‘type 2’ when it develops after injury to a nerve.
The condition may occur in anyone and there is no way of predicting it. It has no correlation with the severity of injury and is more often seen following minor injuries.
Most cases are fortunately mild and will resolve. It may occur in as often as 5% of all injuries, 15% of peripheral nerve injuries and following 10-30% of hand & wrist fractures. It seems to be more common in females.
What are the symptoms and how is the condition diagnosed?
The symptoms are variable and individually vary. The main complaint is of intense (burning) pain, which gets worse over time. The other symptoms are of hypersensitivity, temperature changes, colour changes, thin / shiny skin, changes in hair and nail growth, stiffness, muscle wasting and decreased movement.
Will further tests or investigations be needed?
The diagnosis is clinical but sometimes tests like bone scans, x-rays and MR scan may be suggested.
What is the treatment?
- There are many treatment modalities available and recommendations will change according to the specific case. However, it is important to use the affected limb as normally as possible. Pacing your activities will help.
- The aim of treatment is to provide adequate pain relief in order to undertake rehabilitation with the primary aim of restoring function.
- Pain control is usually achieved by medication. Sometimes a TENS machine is used. It provides electric impulses to the nerve endings. .
- Physiotherapy is the mainstay of treatment. The treatment is aimed at regaining motion and preventing irreversible stiffness of the limb. Special splints to prevent any contractures may be needed. Treatment may involve biofeedback techniques.
- In severe cases, referral to specialist pain management programmes, with use of injections to block pain fibres in the affected nerves, may be needed. In very severe cases the Consultant Pain Physician may recommend complex pain control measures like spinal cord stimulation or intrathecal drug pumps to deliver strong analgesics (opioids) and local anaesthetic agents via the spinal cord.
