Complex regional pain syndrome
Complex regional pain syndrome: Excerpt from Handbook of Diseases
Complex regional pain syndrome (CRPS), also known as reflex sympathetic dystrophy (CRPS1) or causalgia (CRPS2), is a chronic pain disorder that results from abnormal healing after an injury — either minor or major — to a bone, muscle, or nerve. The development of symptoms is commonly disproportionate to the severity of the injury and seems to result from abnormal functioning of the sympathetic nervous system, the part of the nervous system that controls the diameter of blood vessels. One or more extremities and other parts of the body may be affected. CRPS may also be seen in postoperative patients and in patients with diseases that can cause chronic pain, such as cancer and arthritis.
Causes
The exact cause of CRPS is unknown. Impaired communication between the damaged nerves of the sympathetic nervous system and the brain may cause interference with normal signals for sensations, temperature, and blood flow. Infection or injury to an area or leg may initiate CRPS.
Signs and symptoms
Patients usually report severe and constant pain. The affected area may have altered blood flow, feeling either warm or cool to the touch, with discooration, sweating, or swelling. In time, skin, hair, and nail changes may occur along with impaired mobility and muscle wasting, especially if treatment is delayed.
Diagnostic tests
There is no laboratory test for CRPS, so the diagnosis is based on the patient’s history and clinical findings. A history of injury to an extremity may point to CRPS. Bone X-rays may aid in ruling out other conditions, such as osteomyelitis and stress fractures, which cause similar signs and symptoms. With early diagnosis, prognosis improves.
Treatment
Treatment options include drug therapy (such as an anti-inflammatory, an antidepressant, a vasodilator, and an analgesic), physical therapy to the injured area, and psychological support.
Techniques for interrupting the hyperactivity of the sympathetic nervous system, such as nerve or regional blocks, may also be included.
Special considerations
❑ Offer emotional support to the patient and his family. Teach them about the disease.
❑ Monitor effects of prescribed medications.
❑ In addition to attending physical therapy sessions, the patient may need a home therapy regimen that includes stretching, active and passive exercises, strengthening exercises, compressive stockings or gloves to control edema, and heat or cold pack applications.
❑ Consult a pain care specialist to provide additional options for the patient, and help manage discomfort.
❑ Because chronic pain can be an emotional burden to the patient and his family, provide information on resources, such as counseling, support groups, stress-reduction methods, meditation, relaxation training, and hypnosis.
Book Source Details
- Book Title: Handbook of Diseases
- Author(s): Springhouse
- Year of Publication: 2003
- Copyright Details: Handbook of Diseases, Copyright © 2003 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Handbook of Diseases
Authors: Springhouse
Publisher: Lippincott Williams & Wilkins
Copyright: 2003
ISBN: 1-58255-266-5
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