Complex regional pain syndrome

Subject: Complex regional pain syndrome Thu Jan 20, 2011 9:26 pm

Complex regional pain syndrome
Filed under: Pain Management
Complex regional pain syndrome (CRPS) is an uncommon, chronic condition
that usually affects your arm or leg. Rarely, complex regional pain
syndrome can affect other parts of your body.

Complex regional pain syndrome is marked by intense burning or aching
pain. You may also experience swelling, skin discoloration, altered
temperature, abnormal sweating and hypersensitivity in the affected
area.

The cause of complex regional pain syndrome isn't clearly understood,
though it often follows an illness or injury. Treatment for complex
regional pain syndrome is most effective when started early. In such
cases, dramatic improvement and even remission are possible.

©1998-2011 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.
Expand Arrow DownSymptoms

The main symptom of complex regional pain syndrome is intense pain,
which gets worse over time. Additional signs and symptoms include:

* "Burning" pain in your arm, leg, hand or foot.
* Skin sensitivity.
* Changes in skin temperature, color and texture. At times your skin
may be sweaty; at other times it may be cold. Skin color can range from
white and mottled to red or blue. Skin may become tender, thin or shiny
in the affected area.
* Changes in hair and nail growth.
* Joint stiffness, swelling and damage.
* Muscle spasms, weakness and loss (atrophy).
* Decreased ability to move the affected body part.

Symptoms may change over time and vary from person to person. Most
commonly, swelling, redness, noticeable changes in temperature and
hypersensitivity (particularly to cold and touch) occur first. Over
time, the affected limb can become cold and pale and undergo skin and
nail changes as well as muscle spasms and tightening. Once these changes
occur, the condition is often irreversible.

When to see a doctor
If you experience constant, severe pain that affects a limb and makes
touching or moving that limb seem intolerable, see your doctor to
determine the cause. It's important to treat complex regional pain
syndrome early.

©1998-2011 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.
Expand Arrow DownCauses

Complex regional pain syndrome occurs in two types with similar signs and symptoms, but different causes:

* Type 1. Previously known as reflex sympathetic dystrophy syndrome,
this type occurs after an illness or injury that didn't directly damage
the nerves in your affected limb. About 90 percent of people with
complex regional pain syndrome have type 1.
* Type 2. Once referred to as causalgia, this type follows a distinct nerve injury.

Many cases of complex regional pain syndrome occur after a forceful
trauma to an arm or a leg, such as a gunshot wound or shrapnel blast.
Other major and minor traumas — such as surgery, heart attacks,
infections, fractures and even sprained ankles — also can lead to
complex regional pain syndrome. It's not well understood why these
injuries can trigger complex regional pain syndrome.

©1998-2011 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.
Expand Arrow DownComplications

If complex regional pain syndrome isn't diagnosed and treated at an
early stage, the disease may progress to more disabling signs and
symptoms. These may include:

* Muscle wasting (atrophy). If you avoid moving an arm or a leg
because of pain or if you have trouble moving a limb because of
stiffness, your skin and muscles may begin wasting.
* Contracture. You may also experience tightening of your muscles.
This may lead to a condition in which your hand and fingers or your foot
and toes contract into a fixed position.

Complex regional pain syndrome occasionally may spread from its source to elsewhere in your body in these patterns:

* Continuity type. The symptoms may migrate from the initial site of
the pain — for example, from your hand to your shoulder, trunk and
face.
* Mirror-image type. The symptoms may spread from one limb to the opposite limb.
* Independent type. Sometimes, the symptoms may leap to a distant part of your body.

©1998-2011 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.
Expand Arrow DownPreparing for your appointment

To get the best medical care, take time to prepare for your appointment.
If you suspect you have complex regional pain syndrome, write down any
symptoms you're experiencing — including the severity and location of
your pain, stiffness or sensitivity. It's also a good idea to write down
any questions you have for your doctor.

What to expect from your doctor
Your doctor is likely to ask you a number of questions, as well. Being
ready to answer them may reserve time to go over any points you want to
spend more time on. For complex regional pain syndrome, your doctor may
ask:

* Have you had a recent accident, illness or injury, such as trauma to your limbs, a heart attack or an infection?
* Have you had surgery recently?
* When did you first begin experiencing pain or burning?
* How long have you been experiencing your symptoms?
* Is the pain occasional or continual?
* Does anything seem to improve or worsen your symptoms?
* Have you experienced similar symptoms after past injuries?

©1998-2011 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.
Expand Arrow DownTests and diagnosis

Diagnosis of complex regional pain syndrome is based on a physical exam
and your medical history. There is no single test that can definitively
diagnose complex regional pain syndrome, but the following procedures
may provide important clues:

* Bone scan. A radioactive substance injected into one of your veins
permits viewing of your bones with a special camera. This procedure may
show increased circulation to the joints in the affected area.
* Sympathetic nervous system tests. These tests look for
disturbances in your sympathetic nervous system. For example,
thermography measures the skin temperature and blood flow of your
affected and unaffected limbs. Other tests can measure the amount of
sweat on both limbs. Dissimilar results can indicate complex regional
pain syndrome.
* X-rays. Loss of minerals from your bones may show up on an X-ray in later stages of the disease.
* Magnetic resonance imaging (MRI). Images captured by an MRI device may show a number of tissue changes.

©1998-2011 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.
Expand Arrow DownTreatments and drugs

Dramatic improvement and even remission of complex regional pain
syndrome is possible if treatment begins within a few months of your
first symptoms. Often, a combination of various therapies is necessary.
Your doctor will tailor your treatment based on your specific case.
Treatment options include:

Medications
Doctors use various medications to treat the symptoms of complex
regional pain syndrome. Over-the-counter nonsteroidal anti-inflammatory
drugs (NSAIDs), such as aspirin, ibuprofen (Advil, Motrin, others) and
naproxen sodium (Aleve), may ease pain and inflammation. In some cases,
doctors may recommend prescription medications. For example,
antidepressants, such as amitriptyline, and anticonvulsants, such as
gabapentin (Neurontin), are used to treat pain that originates from a
damaged nerve (neuropathic pain). Corticosteroids, such as prednisone,
may reduce inflammation.

Your doctor may suggest bone-loss medications, such as alendronate
(Fosamax) and calcitonin (Miacalcin). Opioid medications may be another
option. Taken in appropriate doses, they may provide acceptable control
of pain. However, they may not be appropriate if you have a history of
substance abuse or lung disease.

Some pain medications, such as COX-2 inhibitors (Celebrex), may increase
your risk of heart attack and stroke. It's wise to discuss your
individual risks with your doctor.

Therapies

* Applying heat and cold. Applying cold may relieve swelling and
sweating. If the affected area is cool, applying heat may offer relief.
* Topical analgesics. Various creams are available that may reduce
hypersensitivity, such as lidocaine or a combination of ketamine,
clonidine and amitriptyline.
* Physical therapy. Gentle, guided exercising of the affected limbs
may improve range of motion and strength. The earlier the disease is
diagnosed, the more effective exercises may be.
* Sympathetic nerve-blocking medication. Injection of an anesthetic
to block pain fibers in your affected nerves may relieve pain in some
people.
* Transcutaneous electrical nerve stimulation (TENS). Chronic pain
is sometimes eased by applying electrical impulses to nerve endings.
* Biofeedback. In some cases, learning biofeedback techniques may
help. In biofeedback, you learn to become more aware of your body so
that you can relax your body and relieve pain.
* Spinal cord stimulation. Your doctor inserts tiny electrodes along
your spinal cord. A small electrical current delivered to the spinal
cord results in pain relief.

©1998-2011 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.
Expand Arrow DownCoping and support

Living with a chronic, painful condition can be challenging, especially
when — as is often the case with complex regional pain syndrome — your
friends and family don't believe you could be feeling as much pain as
you describe. Share information from reliable sources about complex
regional pain syndrome with those close to you to help them understand
what you're experiencing.

Take care of your physical and mental health by following these suggestions:

* Maintain normal daily activities as best you can.
* Pace yourself and be sure to get the rest that you need.
* Stay connected with friends and family.
* Continue to pursue hobbies that you enjoy and are able to do.

If complex regional pain syndrome makes it difficult for you to do
things you enjoy, ask your doctor about ways to get around the
obstacles.

Keep in mind that your physical health can directly affect your mental
health. Denial, anger and frustration are common with chronic illnesses.

At times, you may need more tools to deal with your emotions.
Professionals including therapists or behavioral psychologists may be
able to help you put things in perspective. They can also teach you
coping skills that may help you, including relaxation techniques.

Sometimes, joining a support group, where you can share experiences and
feelings with other people, is a good approach. Ask your doctor what
support groups are available in your community.

©
Prevention

The following measures may help you reduce the risk of contracting complex regional pain syndrome:

* Taking vitamin C after a wrist fracture. Studies have shown that
people who take daily vitamin C supplements after wrist fracture have a
lower risk of complex regional pain syndrome compared with those who
don't take vitamin C.
* Early mobilization after a stroke. Some research suggests that
people who get out of bed and walk around soon after a stroke (early
mobilization) lower their risk of complex regional pain syndrome.

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