Experiencing High Pain? Could it be Complex Regional Pain Syndrome?

What are the other names for CRPS?

Complex Regional Pain Syndrome (CRPS) has been known as Reflex Sympathetic Dystrophy, Arm and Neck Syndrome, Causalgia, Reflex Neurovascular Dystrophy and Amplified Musculoskeletal Pain Syndrome to name a few. I am also sure that each person who has had to live with this condition has some other personal names they use to describe it!

CRPS blurred

How can Complex Regional Pain Syndrome be diagnosed?

It can occur after simple injuries such as a sprained ankle or muscle strain in sport. It is diagnosed using The Budapest Criteria, a list of signs and symptoms, which were published as a result of a workshop held in Budapest in 2003. The Budapest Criteria considers severe unremitting pain above and beyond the normal healing times for a condition to be the strongest indicator of CRPS coupled with a combination of several other signs and symptoms. One in isolation does not indicate a firm diagnosis of CRPS as they can exist on their own or due to other condition, so multiple symptoms have to be present for firm diagnosis. You need to compare the unaffected side with the affected side.

Symptoms can include:

  • Severe pain often not in proportion to what you would expect from the injury you had – Hyperalgesia
  • Severe pain in areas not injured or damaged – Allodynia
  • Increased sensitivity of your skin
  • Excess hair growth
  • Change in skin temperature – warm or cold
  • Skin can be excessively sweaty or dry or flaky
  • Change in colour of skin ie. Redness or blue colour
  • Change in the finger nails
  • Some spasms in the muscles of contracting without reason

A physiotherapist is ideally placed to assess and monitor for these signs and symptoms, and to enable a diagnosis to be confirmed as quickly as possible. This is essential as we know that diagnosis can take multiple visits to different medical professionals if not assessed accurately and a delay in diagnosis delays treatment and inevitably leads to a poorer outcome.

CPRS has two main types:  one which occurs after an injury or illness which did not cause nerve damage and one which follows a nerve injury.  However, both types go through the same 2 stages of the disease.

Complex Regional Pain Syndrome Stages comprise of:

Stage 1 – Acute
A burning painful sensation and sensitivity upon touch is followed by swelling and stiffness.

Stage 2 – Dystrophic
After around 3 months, the skin around the affected area will become cooler, the pain will spread and sensitivity will increase.

Stage 3 – Atrophic
After 1 year, the skin will become pale, dry and shiny.  There is increased stiffness and the condition may also spread to other parts of the body. 

What is the treatment for Complex Regional Pain Syndrome?

Once a clear diagnosis of CRPS has been established there are many and varied treatment options. What is clear from the literature is that adequate pain management is essential. Speaking with your GP or Consultant about neuropathic pain medications to treat this type of pain is important. Physiotherapists are well versed in discussing the best management strategies for CRPS with GP’s and consultants, and can be very helpful in enabling a clear plan to be put in placed with the team of people looking after you.

It is also essential that physiotherapy rehabilitation be closely linked to the symptoms you are exhibiting. These can vary from patient to patient, and different parts of the body can be affected by CPRS so treatment must vary. Commonly symptoms and signs include severe pain, hyperalgesia (extreme pain in an area of previous injury), allodynia (extreme pain in areas not previously injured or damaged), excessive sweating, excessive hair growth, skin colour changes, variability in temperature of the limb and other skin changes such as flaking and cracking that hasn’t occurred on the unaffected side. Comparison to the healthy side is essential. Careful discussion of how the limb reacts at different times of the day is important, as symptoms can change during a 24 hour period making assessment all that more tricky.

Some of the treatments that can help include:

  • • functional movement re-education (teaching how to move properly again)
    • mood lifting techniques
    • Graded Motor Imagery (below)
    • de-sensitisation
    • tai chi
    • acupuncture
    • gradual progression of exercise
    • relaxation
    • hydrotherapy
    • pacing techniques

CRPS is not a quick or simple condition to recover from, but with good treatment at the earliest possible point and with clear education on the best management it is possible to fully recover.

What is GMI (Graded Motor Imagery)?

It is a rehab programme aimed at retraining the brain (below) When pain or movement problems are related to changes in the nervous system this rehab programme uses three techniques including left/right discrimination, motor imagery and mirror therapy.

GMIGMI PNG

From www.gradedmotorimagery.com

 

If you think you or a family member might be developing CRPS after what seemed like a small or simple injury then please contact us today to discuss your symptoms. Contact us today on 020 7884 0374 or email info@physiocomestoyou.com.