Complex Regional Pain Syndrome (CRPS)

Complex Regional Pain Syndrome (CRPS) is one of the causes of persisting limb pain. It can occur after surgery or injury and sometimes the injury is so trivial that you may not even remember it. In other cases the injury may be more severe with or without nerve damage. The pain however lasts much longer and is more severe than expected. It can range from mild self-limiting to chronic debilitating condition affecting activities of daily living and quality of life. The reason why CRPS develops is unclear and multiple mechanisms are thought to be involved. A combination of signs and symptoms is used to make the diagnosis as there is no specific diagnostic test. Investigations are helpful to exclude other conditions such as infection and rheumatologic conditions which may have similar presentation.
Pain in CRPS is accompanied by other signs and symptoms such as

Hypersensitivity of the affected limbr
Swelling, abnormal sweatingr
Involved limb may feel unusually cold or warm with or without colour changesr
Nail, skin and hair changesr
Stiffness, weakness, abnormal tone of muscles and jerky movementsr
Managementr
The aim in CRPS management is pain control and functional recovery. Early diagnosis and treatment using multi- disciplinary approach is preferred. Your pain management specialist may recommend interventions such as intravenous drug infusions, sympathetic blocks such as stellate ganglion block or lumbar sympathetic blocks and neuromodulation. These are used in combination with medications, physiotherapy and psychology input.

Medications prescribed depend on the phase of disease and the predominant symptoms. A combination of anti inflammatory drugs, neuropathic medications and opioids is commonly utilised. Some other medications including bisphosphonates, free radical scavengers (topical 50% dimethylsulfoxide- DMSO), oral steroids etc. may also be used.

Your physiotherapist will teach you desensitisation techniques if the limb sensitivity is increased. It helps in preventing problems due to weakening and reduced usage of the affected limb. Strengthening exercises are incorporated as the pain is adequately controlled. He may consider specialist interventions such as mirror therapy or graded motor imagery if indicated.