Complex Regional Pain Syndrome
Complex regional pain syndrome (CRPS) is a chronic condition characterized by
severe burning pain, pathological changes in bone and skin, excessive sweating,
tissue swelling, and extreme sensitivity to touch. The syndrome is a nerve disorder
that occurs at the site of an injury (most often to the arms or legs). It occurs
especially after injuries from high-velocity impacts such as those from bullets
or shrapnel. However, it may occur without apparent injury. One visible sign
of CRPS near the site of injury is warm, shiny red skin that later becomes cool
and bluish.The pain that patients report is out of proportion to the severity
of the injury and gets worse, rather than better, over time. Eventually the
joints become stiff from disuse, and the skin, muscles, and bone atrophy. The
symptoms of CRPS vary in severity and duration. The cause of CRPS is unknown.
The disorder is unique in that it simultaneously affects the nerves, skin, muscles,
blood vessels, and bones. CRPS can strike at any age but is more common between
the ages of 40 and 60, although the number of CRPS cases among adolescents and
young adults is increasing. CRPS is diagnosed primarily through observation
of the symptoms. Some physicians use thermography to detect changes in body
temperature that are common in CRPS. X-rays may also show changes in the bone.
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Physicians use a variety of drugs to treat CRPS.
Elevation of the extremity and physical therapy are also used to
treat CRPS. Injection of a local anestheticis usually the first step
in treatment. TENS (transcutaneous electrical stimulation), a
procedure in which brief pulses of electricity are applied to nerve
endings under the skin, has helped some patients in relieving
chronic pain. In some cases, surgical or chemical sympathectomy --
interruption of the affected portion of the sympathetic nervous
system -- is necessary to relieve pain. Surgical sympathectomy
involves cutting the nerve or nerves, destroying the pain almost
instantly, but surgery may also destroy other sensations as well.
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Good progress can be made in treating CRPS if
treatment is begun early, ideally within three months of the first
symptoms. Early treatment often results in remission. If treatment
is delayed, however, the disorder can quickly spread to the entire
limb, and changes in bone and muscle may become irreversible. In 50
percent of CRPS cases, pain persists longer than 6months and
sometimes for years.
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Investigators are studying new approaches to treat CRPS
and intervene more aggressively after traumatic injury to lower the
patient's chances of developing the disorder. Scientists are
studying how signals of the sympathetic nervous system cause pain in
CRPS patients. Using a technique called microneurography, these
investigators are able to record and measure neural activity in
single nerve fibers of affected patients. By testing various
hypotheses, these researchers hope to discover the unique mechanism
that causes the spontaneous pain of CRPS, and that discovery may
lead to new ways of blocking pain.
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American
Chronic Pain Association (ACPA)
National Chronic Pain Outreach Association
(NCPOA)
Reflex
Sympathetic Dystrophy Syndrome Association (RSDSA)
American
RSDHope Group
National
Foundation for the Treatment of Pain
American
Pain Foundation
National
Headache Foundation
Mayday
Fund [For Pain Research]
International
Research Foundation for RSD/CRPS
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