Complex Regional Pain Syndrome

Complex Regional Pain Syndrome(CRPS) originally was recognized during the American Civil War. It was noted that injury to major nerves by gunshot wound or stab wound resulted in pain that was out of proportion to extent of injury. It was described as “causalgia.” This term was replaced by Complex Regional Pain Syndrome Type II (CRPS type II).  This disease is also known as Reflex Sympathetic Dystrophy (RSD).  Because the “complex” nature of presentations and respond to therapies, the name was changed to “Complex” Regional Pain Syndrome. As opposed to CRPS type II, CRPS type I is as a result of injury to soft tissues, recognized or unrecognized. Studies have shown that injury to pain sensory nerves can initiate Complex Regional Pain Syndrome. This pain syndrome can present itself as a pain that is not familiar to the patient. It is described as burning, stabbing, spontaneous, radiating, and at times sensitive to touch. It is common to describe a pain that is initiated by light touch. There is also possibility of sensitivity to cold temperature or warm temperature.  One might notice temperature differences between the left and the right extremity. Color changes usually is described as purplish bluish discoloration.  Swelling at the site of the original injury can be intermittent.  Changes in the texture of the skin can present in form of developing shiny skin, thinning of the skin, hair loss or accelerated hair growth, and pitting of the nailbeds.  Complex Regional Pain Syndrome also can cause asymmetrical sweating in the upper extremities, meaning that there is an abnormal sweating in one of the limbs when one compares the left side to the right side. If it is not treated, it may spread to other structures. The treatments of the Complex Regional Pain Syndrome include sympathetic ganglion blockade, medications, physical therapy, behavioral medical therapy, neurostimulation, and other modes of drug delivery. The term “great imitator” has been assigned to this disease because it involves other structures and systems with variety of presentations. cardiac complications, lethargy, local and generalized weakness, cognitive dysfunction such as poor memory, tactile and proprioceptive deficits such as feeling strange sensation that comes from the muscles, tendons, and other internal tissues, tremor, respiratory complications in form of restrictive lung disease and shortness of breath, neurogenic inflammation causing perpetuation of the inflammatory process, musculoskeletal disease presenting as myofascial pain with tender points, muscle atrophy, and muscle weakness. Complex regional pain syndrome can also affect endocrine system (affecting hormones), gastrointestinal system presenting as constipation, diarrhea, nausea, vomiting, acid reflux (indigestion), irritable bowel syndrome, and difficulty swallowing. Urinary frequency and urgency has been reported. In light of its systemic manifestations, now the time has come to question the name “regional” in Complex Regional Pain Syndrome.  We at Rochester Pain Management have had extensive experience with this pain disorder and ready to provide you with a care that optimizes your chance to control this disease.