What is CRPS?

Complex Regional Pain Syndrome, or CRPS, is a rare, chronic disorder characterized by a disproportionate level of pain in a particular area of the body, typically a limb. In about 90% of cases, it develops after an injury or trauma, and research has also shown that the risk tends to be higher for patients with complicated fractures or a rheumatological disease. CRPS is a quite uncommon condition that can affect people of any age, but it is most common in women between the ages of 40 and 60.

There are two types of CRPS: type 1, also known as Reflex Sympathetic Dystrophy (RSD), and type 2, also known as causalgia. The main difference between the two is that type 1 develops with no evident nerve damage, whereas in type 2, nerve damage does occur. However, type 2 is extremely uncommon; about 90% of CRPS cases are type 1.

If you are dealing with CRPS, our pain management specialists can help you find long-term relief.

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The Symptoms: What Makes CRPS Different?

So, what exactly is the difference between the pain caused by CRPS and other types of pain? Well, in its early stages, CRPS pain usually comes with other inflammatory symptoms like swelling of the limb and changes in skin color or temperature. Not only that, but it is also a deeper kind of pain that increases with even subtle contact or movements or exposure to temperature changes. A CRPS patient will also typically experience a limited use of their affected area due to the intense pain.

CRPS Stages and Symptoms

Generally, there are 3 stages of Complex Regional Pain Syndrome, and as it further progresses, symptoms intensify and new ones appear.

Stage 1

This stage usually lasts from 1 to 3 months, and patients may experience symptoms like:

  • Severe pain and burning sensation
  • Excessive sensitivity to pain stimulus (hyperesthesia)
  • Changes in the skin: temperature fluctuations (between hot and cold), changes in color (it may become pale pink, red, or even blue or purple), and texture (blotched or shiny)
  • Rapid hair and nail growth
  • Muscle spasms or tremors
  • Swollen and stiff joints
  • Increased sweating

Stage 2

This stage can last between 3 and 6 months, and it is when symptoms really progress. Pain intensifies, hair growth slows down and nails become brittle, joint swelling and stiffness increase, and muscles become weaker. Pain may also spread to other areas of the body that were initially unaffected.

Stage 3

The chronic phase of CRPS can develop up to a year after its initial onset, and it can become permanent. At this point, the use of the affected limb becomes too difficult due to the intensity of the pain, and this causes weakening and atrophy of the muscles and tendons, which may eventually lead to permanent contractures.

This is why it’s crucial that CRPS is diagnosed and treated early; even though it tends to be a permanent condition, there is a chance it can disappear completely if treated at the right time. Nonetheless, CRPS treatment can significantly reduce pain and help slow down symptoms. Our goal is to help CRPS patients manage their pain effectively in order to live a full, healthy life, even if some symptoms are present. If you are looking for a CRPS specialist in NJ or PA, don’t hesitate to contact us to get a consultation or schedule an appointment.

The Causes: The Most Complex Part of CRPS

The exact cause of CRPS remains unclear, but there are multiple factors that may be involved in its development. Some experts also have some theories about it such as:

  • A neurological overreaction to an injury
  • Unusual triggers of pain mechanisms by the immune system
  • Excessive inflammation in the nervous system

What Is (Partially) Known

Aside from the fact that CRPS is an abnormal neurological response, it is also known that it tends to occur as a response to trauma or injury, such as fractures, sprains, or surgery. In fact, more than 90% of cases are triggered by injury. However, most people who suffer these types of injuries don’t get CRPS—and there is no clear explanation as to why a minority does.

Immobilization after fractures or surgery, such as casting, has also been associated with CRPS, specifically type I. This can often cause an increase in pain sensitivity, edema, or changes in temperature in the affected limb, which is why it may contribute to the development of the condition.

Inflammation has been widely discussed in CRPS research. It has been found that patients in the early stages of CRPS have increased levels of cytokines, which are inflammatory substances released by the body. Along with this, there is also an irregular release of other pain-producing substances in the nerves.

Genetics may also be involved in CRPS, although not directly. There are some genes that affect the immune system and can make a person more prone to inflammation, and thus some genetic patterns may increase the risk of developing CRPS, but this is still relatively unclear and genetic factors alone cannot be attributed to its cause.

Other, less common causes of CRPS include heart attacks and strokes.

The Diagnosis

Diagnosis of complex regional pain syndrome is quite challenging and usually a combination of various examinations. The foundation is usually a physical examination to observe symptoms—however, these symptoms must be observed over time to actually make a diagnosis. Tests such as X-rays, bone scans, MRI, thermography, skin sensitivity tests, or nerve conduction tests can be used to support the diagnosis. There are also some tests that are used to help rule out other conditions that may have similar symptoms.

The ‘Budapest Criteria’ Approach

The truth of the matter is, there is no specific method that can help diagnose CRPS definitively. However, the Budapest Criteria is the best available method so far. The Budapest Criteria are a set of guidelines that were adopted in 2004 in a conference held in Budapest by the International Association for the Study of Pain (IASP) to determine whether or not a patient meets CRPS diagnostic criteria. They consist of differentiating signs, which are seen or felt by the examiner, and symptoms, which are experienced by the patient and reported to the examiner.

Signs and Symptoms

In order to get a CRPS diagnosis through the Budapest Criteria, at least one sign must be noticeable to the examiner in at least two of the following categories, and the patient must present at least one symptom in at least three of the following categories:

  • Sensory: Changes in pain sensitivity; hyperalgesia, which is an increased sensitivity to pain, and/or allodynia, which is pain from stimuli that is usually non-painful.
  • Vasomotor: Alterations to blood vessels that manifest as temperature differences between the limb, and/or changes in skin color.
  • Sudomotor: Changes in sweating, usually increased sweating even without any exertion and/or edema.
  • Motor/trophic: Decreased range of motion due to pain and/or motor dysfunction and/or trophic changes (changes in skin, hair, and nails).

The Treatments: What is Actually Known

Even though it technically has no definite cure, various types of CRPS treatment options are available and typically focus on managing pain, slowing the progression of the condition, improving mobility, and relieving symptoms overall. The key is that CRPS is diagnosed and treated early.

First-line treatments for CRPS patients are usually physical therapy, which is important for movement, flexibility, and strength, and occupational therapy, which helps them learn new ways to make everyday tasks easier. Medications are also used to manage pain; however, there is no single medication or combination of medications that works for every patient equally. Some of these may include bisphosphonates, anti-inflammatory drugs, corticosteroids (steroid medications), and even antidepressants (even if the person is not depressed, the chemical changes these types of drugs cause in the brain can help reduce pain and improve sleep).

When non-invasive treatments are not effective, there are other CRPS treatment options such as pain management injections, nerve blocks, radiofrequency ablation (RFA), or spinal cord stimulation (SCS)—all minimally invasive procedures.

At our CRPS treatment centers, one of the treatments most recommended by our specialists is spinal cord stimulation. This minimally invasive treatment consists of inserting a small device under the skin that disrupts pain signals before they get to the brain. Studies have shown that this procedure is highly effective and safe, and it provides long-term pain relief with no medication. If you are looking for an option that doesn’t involve surgery or haven’t found relief with other types of therapy, SCS might be a good choice.

Our CRPS specialists in NJ and PA are highly skilled, compassionate individuals that will evaluate your case thoroughly and design a customized plan for your needs. We guarantee you will receive the best care and the most effective treatments to help you feel your best and improve your quality of life.

The Importance of Mental Health When Living With CRPS

Living with a chronic pain condition not only puts stress on your physical health, but also on your mental and emotional health. For many patients, this can lead to mental illnesses like depression or anxiety, which, in turn, can worsen pain perception and make everyday life more draining.

We recommend always addressing these mental and emotional changes and, if needed, getting additional help from a therapist to complement CRPS treatment. Taking care of yourself and getting to know your mind-body connection when living with chronic pain can make a bigger difference than you imagine.

Additionally, some daily self-care strategies you can implement into your life to help you manage CRPS are:

  • Having a healthy, nutritious diet: the key is focusing on natural, whole foods and avoiding highly processed foods.
  • Moving your body: exercise will not only help improve mobility, flexibility, and strength (and thus reduce pain) but also your mental and emotional health.
  • Getting a good quality of sleep: rest is essential for overall health, and will also aid you in your pain management journey.

CRPS causes severe, chronic pain that can make daily life significantly challenging. At Premier Pain Management, we want to make a difference in your life and help you cope with pain in the best way possible. Request a consultation below to learn more about us and our pain treatments, or to schedule an appointment with one of our specialists.

FAQs

  • What are the benefits of Premier’s approach to pain management?

At Premier Pain Clinics, we focus on comprehensive pain management, which combines different techniques to provide each patient with the optimal treatment for their particular case. This approach involves a number of treatment options such as alternative therapies, interventional procedures, physical therapies, etc., and allows us to create a holistic, personalized treatment plan for your needs.

  • Is Spinal Cord Stimulation the best treatment option for CRPS?

In Spinal Cord Stimulation or SCS, we implant a small device under the skin that delivers electrical stimulation to the nerves in the spinal cord. This “disguises” pain signals coming from the affected limb, replacing them with a soft tingling sensation, or with no sensation at all. This is often the best option (studies show that it can significantly decrease CPRS pain by more than 50%) and is especially ideal for CRPS patients for whom other therapies have not worked.

  • Is Spinal Cord Stimulation safe?

SCS is a very safe, minimally invasive procedure that allows most patients to return home the same day. There are some risks—as with all medical procedures—such as bleeding, infection, and allergic reaction to the device; but they are rare.

  • How can I schedule an appointment with a specialist?

You can leave us your information in the contact form below and we will get back to you as soon as possible to help you schedule an appointment and solve any questions you may have. If you want to schedule an appointment directly, you can call us at (973) 531 2199 Monday through Friday from 8:00 AM to 5:00 PM.