Complex Regional Pain Syndrome

Complex regional pain syndrome (CRPS) is a chronic progressive disease characterized by severe pain, swelling and changes in the skin.

There are two types:

• Type I, formerly known as reflex sympathetic dystrophy (RSD), does not have demonstrable nerve lesions.
• Type II, formerly known as causalgia, has evidence of obvious nerve damage.
• The cause of this syndrome is currently unknown. Precipitating factors include injury and surgery, although there are documented cases that have no demonstrable injury to the original site.
• The most common symptoms overall are burning and electrical sensations, described to be like “shooting pain.” The patient may also experience swelling, increased sweating, changes in skin temperature and colour, softening and thinning of bones, joint tenderness or stiffness, restricted or painful movement.
• The management of CRPS is often multi-disciplinary, with the use of different types of medications combined with distinct physical therapies.
• Medications for CRPS include NSAIDS, antidepressants, antiepileptics, lignocaine patch and opioids.
• Intravenous guanethedine block and sympathetic blocks like stellate ganglion or lumbar sympathetic blocks are effective in some cases.
• Physiotherapy and occupational therapy play a vital role in the management of CRPS by desensitizing the affected body part, restoring motion, and improving function. Some people with CRPS are incapable of participating in physical therapy due to touch intolerance. This may be where Graded Motor Imagery and Mirror Box Therapy are helpful.
• Intravenous lignocaine and ketamine infusion has been used successfully to manage CRPS.
• Spinal cord stimulator may also be used to reduce the pain by directly stimulating the spinal cord. These devices place electrodes either in the epidural space or directly over nerves located outside the central nervous system.