CRPS is RSD = Pain

Complex Regional Pain Syndrome - Information - Symptoms - Treatment

REVIEW

Reflex sympathetic dystrophy syndrome, or RSDS, is known by many names. These include causalgia, Sudeck’s atrophy, shoulder-hand syndrome and regional complex pain syndrome. Complex Regional Pain Syndrome (CRPS) is the current name of Reflex Sympathetic Dystrophy Syndrome (RSDS).

CRPS is a very debilitating disorder that begins after nerve injury. The nerves become hypersensitive and severe pain is felt in situations that are not normally painful. CRPS is a chronic pain syndrome with two forms. CRPS 1 currently replaces the term "reflex sympathetic dystrophy syndrome". It is a chronic nerve disorder that occurs most often in the arms or legs after a minor or major injury. Type one can occur in the absence of nerve injury. Type two occurs after damage to a nerve in the injured arm or leg. CRPS 1 is associated with severe pain; changes in the nails, bone, and skin; and an increased sensitivity to touch in the affected limb. In most cases CRPS has 3 stages. Often, however, CRPS does not follow this progression. Some people go into the later stages almost immediately. Others remain in Stage 1 indefinitely.

The pain felt with CRPS is out of proportion in intensity, distribution, and duration of what would be expected from the initial injury. The nature of the pain often fluctuates with external stimuli (changes in temperature/touch) and internal stimuli (life stress/illness). Eventually movement can become limited due to pain and muscle weakness and decreased range of motion develops in the affected arm or leg.

Treatment should be started as early as possible. This may prevent the disease from progressing. Treatment usually includes a combination of therapies. Treatment usually includes a combination of therapies, such as:
Medications -- pain medicines, steroids, blood pressure medicines that work on the sympathetic nervous system, bone loss medications (such as Actonel), and antidepressants Physical or occupational therapy
Applications of heat and cold
The use of a TENS (trancutaneous electrical nerve stimulator) unit
Biofeedback 
Nerve blocks (injecting medicine to numb the affected nerves or pain fibers around the spinal column)
Surgical sympathetomy (radical surgery that involves cutting the nerves to destroy the pain, but other sensations may be destroyed as well)

The outlook is better with an early diagnosis. If the condition is recognized within the first stage, sometimes it may go into remission and normal movement will be possible with minimal changes. However, if it is not diagnosed quickly, deteriorating changes in the bone and muscle may develop rapidly and become irreversible.

Complications
When the disease progresses, the complications include further deterioration of the affected limb, or the spread of the disease to another part of the body. In addition, there are possible complications associated with some of the nerve and surgical treatments.

You should contact your health care provider if you develop constant, burning pain in an arm, leg, hand, or foot. CRPS is a difficult disorder to treat and is a diagnosis of exclusion. However with aggressive physical therapy and medical management, a decrease in the pain intensity and functional improvement can occur.

Let's review RSD!

What is CRPS?
Complex Regional Pain Syndrome (CRPS), also called Reflex Sympathetic Dystrophy Syndrome (RSD) is a chronic neurologic disease characterized by intense and persistent pain. Although CRPS is still classified as a rare disorder (affecting less than 200,000), a newer epidemiological study conducted by de Mos et al** reported that there may be up to 50,000 new CRPS-1 cases annually in the United States. People with the syndrome typically see several physicians before being diagnosed. We are, however, making progress in understanding this little-known and poorly understood syndrome.

CRPS occurs when part of the nervous system and the immune system malfunction as they respond to tissue damage from trauma, such as an injury or a medical procedure. The nerves misfire, sending constant pain signals to the brain. There are two types of CRPS: Type I (RSD) and Type II (Causalgia), which has definite nerve damage.

CRPS is a Physical Disease
Many of the symptoms of CRPS are not visible to others, and often people with the syndrome don’t look sick. It has not been unusual for medical professionals to suggest that people with CRPS exaggerate their pain for psychological reasons. However, research has proven that CRPS is a very real condition.

Telltale Signs and Symptoms of CRPS
CRPS is a diagnostic consideration for people who have moderate-to severe pain that is disproportionate to any inciting event (sprain, fracture, surgery, etc.) and has some of the following characteristics:
* Pain which is described as deep, aching, cold, burning, and/or increased skin
sensitivity
* The presence of an initiating noxious event (sprain, fracture, etc.)
* Continuing pain (moderate to severe) associated with allodynia (pain resulting from a stimulus that normally does not cause pain, such as the touch of clothing or water from a shower), or hyperalgesia (heightened sensitivity to painful stimulation).
* Abnormal swelling in the affected part
* Abnormal hair or nail growth
* Abnormal skin color changes
* Abnormal skin temperature (greater than 1°C asymmetry)
* Abnormal sweating
* Limited range of movement, weakness, or other motor disorders (paralysis, dystonia etc.)
* CRPS is excluded by the existence of conditions that would otherwise account for the degree of pain and dysfunction

http://www.rsdsa.org
**de Mos M, de Bruijn AGJ, Huygen FJPM, Dieleman JP, Stricker BHCh, Sturkenboom MCJM. The incidence of complex regional pain syndrome: A population-based study. Pain. 2007; 129:12-20.