Question 1

What is Complex Regional Pain Syndrome?

Accepted Answer

Complex regional pain syndrome (CRPS) is condition where the pain, and often inflammation, is persistent and severe.  It can affect any part or organ of your body, although is most commonly identifiable in the extremities, such as a single limb. Whether you suffer from acute or chronic CRPS, many people experience combinations of excess and spontaneous bouts of pain. CRPS can develop because of an injury whether an accident at work, car accident, or a fall.

Question 2

What are the Causes of Complex Regional Pain Syndrome?

Accepted Answer

CRPS often results from multiple causes that have similar symptoms. Typically, CRPS follows an injury or trauma. There are two types of CRPS: Reflex Sympathetic Dystrophy (RSD) - Also known as CRPS Type 1, often occurs after an injury or illness that doesn't directly damage nerves in your affected limbs. Causalgia - Otherwise referred to as CRPS Type 2, occurs after a nerve injury. Most cases of CRPS happen after a forceful trauma to a limb, including a fracture or crushing injury. Many times, injury related CRPS is caused by triggering your immune response, leading to inflamed and red areas on the skin. Most people recover from traumatic injuries without lasting effects, but CRPS patients develop severe, long-lasting pain. The pain usually affects their entire limb and can spread throughout the body. This spread is most-common to a contralateral or ipsilateral limbs.

Question 3

What are the Symptoms of Complex Regional Pain Syndrome?

Accepted Answer

The most common symptoms of CRPS include: Spontaneous Pain – Many people say the pain burns or feels as if their body is squeezed. If the nerves remain inflamed, the pain can spread throughout the arms and legs. Excess Pain – Patients report excess pain when the affected area is even lightly touched. You may also experience prolonged discomfort after a mildly painful stimulus. Changes in Skin – often referred to as ‘trophic changes.’ You may notice changes in skin colour, swelling, or temperature of the injured limb. Many people experience blotchy and discoloured skin that fluctuates as abnormal blood flow affects the area. Changes in Nail Beds – This can include a retraction or growth in cuticles and brittle nails. Altered Hair Growth – Sometimes an affected area can become more, or less hairy. Abnormal Sweating – The affected limb may have patches of profuse sweating or no sweating at all due to blood circulation issues. Impaired Muscles – Some people with CRPS report a reduced ability to move the muscles around their affected limb. The lack of movement is due to sensory input abnormalities that control movements, excess inflammation, and poor circulation.

Question 4

How is Complex Regional Pain Syndrome Diagnosed?

Accepted Answer

There is no specific test for CRPS. The best ways to diagnose CRPS include: The Budapest Criteria, Detailed physical examination by the right clinician, Observation of signs and symptoms and recording ongoing changes such as skin discolouration, nail growth, hair growth, increased pain due to change of temperature and pressure etc., Observation of symptoms, Nerve stimulation examination (nerve conduction studies) to rule out any other pathology, Thermal imaging

Question 5

What Complex Regional Pain Syndrome Treatment is Available?

Accepted Answer

Most patients do not recover from CRPS, some can see an improvement over time with treatment and in rare circumstances there may be a full recovery or remission. While there is no cure for CRPS, there are ways to help manage symptoms. Treatment is most often recommended as part of a pain management program within a multi-disciplinary setting, so that clinicians can share data and work collaboratively. The most common CRPS treatments include: Rehabilitation and Physical Therapy – A clinician with expertise in CRPS will be essential, most people cannot bear their affected limb being touched. Mirror therapy can be helpful for some, there are a range of treatment options which can help. Psychotherapy – Patients with severe CRPS often suffer from depression and post-traumatic stress disorder (PTSD) that heightens their pain. It's essential to use psychological treatment to address these issues. Spinal Cord Stimulation – Spinal cord stimulation creates tingling sensations in affected areas to help normalize signaling of the spinal cord and block pain sensations. Some patients report improvement but this is not always suitable for everyone. Nerve Blocks – Nerve blocks may offer pain relief by directly blocking the sympathetic nerves. Medication – Many people with CRPS have struggled to find a suitable medication to help, most try a number to allow them to manage day to day.  Some patients find   non-steroidal anti-inflammatory drugs for inflammation help, medications prescribed for other neuropathic pain conditions, bisphosphonates, and botulinum toxin injections. Suitable medication depends on the type of CRPS. There is growing evidence that opioids offer limited benefit and can lead to additional hyperalgesia (hyper-sensitivity). Cannabinoids – These can help reduce pain. This can be purchased without prescription in the form of CBD oil which is extracted from the cannabis plant. It does not contain THC, so will not give you a high. Medical grade cannabis can be prescribed, although is not yet approved by the NICE Guidelines, there are a few prescribing doctors nationally. It is important to note that high street illegal cannabis may contain a high level of THC, and can lead to psychosis and exacerbate symptoms of depression and anxiety. Cannabis should only be taken in a prescribed dosage.

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