What is CRPS - Complex Regional Pain Syndrome?

What is CRPS?

The International Association for the Study of Pain’s article, What is Complex Regional Pain Syndrome – in plain English; states –

“Complex: Many, many different problems have been identified in people with CRPS. These problems can be severe and usually involve many of our biological systems. This makes the situation complex.

Regional: The symptoms of CRPS are almost always confined to a particular region of the body. The arm or the leg is the most commonly involved region. Sometimes CRPS of one arm spreads to the leg on the same side of the body. Sometimes it spreads to the opposite arm, in which it usually ‘mirrors’ the other one.

Pain: CRPS is exquisitely, severely, painful. Like the other symptoms, the pain is confined to the affected limb or limbs. Often the skin is too tender to touch and the whole limb is too painful to move. In fact, sometimes the limb is too painful to even imagine moving.

Syndrome: A syndrome is a pattern of symptoms that often occur together. Normally, the reason that something is called a syndrome is that we do not know what causes it, we just know that this pattern of symptoms occurs together and usually at the same time.

So, CRPS is the name given to a pattern of symptoms that often occur together”.

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Complex Regional Pain Syndrome (CRPS), is a disorder that can develop after a fracture, surgery, or even a small injury. Distressing and disabling CRPS is characterized by excessive pain, usually in one limb, although it can spread. Changes in skin sensitivity, sweating, hair growth and movement problems are common.

Because CRPS is uncommon, and the range of signs and symptoms, which are not always present, can mimic a large number of other possible conditions, diagnosis may be delayed. CRPS is not evident in x-rays or bone scans and is therefore not easy to diagnose. The diagnostic criteria for CRPS is known as the Budapest criteria.

Treatment will often involve a multidisciplinary approach including; pain specialist, physiotherapy, occupational therapy, psychology, neurology, specialist rehabilitation, and so on. The primary aim is to reduce pain, preserve or restore function, and enable the person with CRPS to manage their condition and improve their quality of life.

The gold standard diagnosis and management of CRPS in Europe and the United Kingdom, published by The Royal College of Physicians and endorsed by the peak representative associations and people with CRPS and their relatives, endorses minimal medications for the treatment of CRPS. These are; codeine, dihydrocodeine, tramadol (only if acute rescue therapy is required, non-steroid anti-inflammatory drugs, paracetamol (as appropriate, Nortriptyline (antidepressant), imipramine (antidepressant), amitriptyline (antidepressant), duloxetine, gabapentin (anticonvulsant), pregabalin (anticonvulsant), intrathecal baclofen treatment (but only in specialised centres).

The guidelines can be accessed here

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All of these photos showcase CRPS in many of its various forms.

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PLEASE NOTE: This information is not intended as medical advice and should not be used for diagnostic purposes. Please seek advice from a qualified medical professional.

The Budapest Criteria, table below, is the diagnostic criteria for CRPS (A-D must apply).

Some possible symptoms of CRPS

Constant chronic pain - The pain, which is usually significantly greater than the original injury or event, is described as deep, aching, cold, burning. Though the affected area may feel cold or hot to touch, the person experiencing the pain feels as though it is literally on fire or freezing.
Allodynia - Extreme sensitivity to touch, sound, temperature and vibration. (Pain from something that should not cause pain - clothing, showering, etc.).
Inflammation - This can affect the appearance of the skin; bruising, mottling, tiny red spots, purplish look, and shiny. As well as the skin temperature and cause excessive sweating, etc.
Spasms - In the blood vessels known as vasoconstriction, and the muscles of the extremities which is sometimes referred to as rolling spasms.
Insomnia & Emotional Disturbances - Includes the major changes to the limbic system such as short-term memory problems, concentration difficulties, sleep disturbances, confusion, etc.
Continuing Moderate to Severe Pain - Associated with hyperalgesia, (an increased sensitivity to painful stimulation).
Injury or Traumatic Event - Fracture, sprain, minor surgery, accident, etc., which should not cause the severe pain being experienced or where the pain does not subside with healing.
Other Physical Issues - Weakness, limited range of motion, paralysis or dystonia.

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At present there is no cure for CRPS, but there is also no cure for diabetes and numerous other health conditions. CRPS is a condition that you will learn to manage, and most people will improve, and live a meaningful life. It is important to start treatment as soon as possible.