Complex regional pain syndrome
Complex regional pain syndrome: Excerpt from Professional Guide to Diseases (Eighth Edition)
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.
Causes and incidence
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. This leads to problems in the nerves, blood vessels, skin, bones, and muscles. Infection or injury to an arm or leg may initiate CRPS. It can also occur after heart attacks and strokes. However, the condition can sometimes appear without obvious injury to the affected limb. This condition is more common in people between ages 40 and 60, but has been seen in younger people too. CRPS may also be seen in postoperative patients and in patients with diseases that can cause chronic pain, such as cancer and arthritis. Annual incidence is unknown because CRPS is often misdiagnosed. However, it has been reported in 1% to 2% of patients with various fractures and in 2% to 5% of patients with peripheral nerve injury.
Signs and symptoms
Patients usually report severe and constant pain; severe pain is common with CRPS2 in particular. The affected area may have altered blood flow, feeling either warm or cool to the touch, with discoloration, sweating, or swelling. In time, skin, hair, and nail changes may occur along with impaired mobility and muscle wasting, especially if adequate treatment is delayed.
Diagnosis
There’s 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. Additional tests may include bone scans, nerve conduction studies, and thermography (a test to show temperature changes and lack of blood supply in the painful area of the affected limb). With early diagnosis, prognosis improves.
Treatment
Treatment typically includes a combination of therapies such as drug therapy, with an anti-inflammatory, antidepressant, vasodilator, and analgesic used singly or in varying combinations, depending on the patient and the severity of symptoms. Steroids may be given in some patients; others may be given bone loss medications such as Actonel. Physical therapy to the injured area, application of heat and cold, the use of a transcutaneous electrical nerve stimulator unit, biofeedback, and psychological support are helpful for some patients.
Treatment may also include techniques for interrupting the hyperactivity of the sympathetic nervous system, such as nerve or regional blocks. Surgical sympathectomy — radical surgery that involves cutting the nerves to destroy the pain — may be done in severe cases; however, this method is rarely used because other sensation may be destroyed in the process.
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: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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