Complex Regional Pain Syndrome (CRPS) or Reflex Sympathetic Dystrophy (RSD)

What is complex regional pain syndrome?

This is a chronic pain syndrome that results in severe pain usually affecting the upper and/or lower extremities, but can also involve other body parts.  Typically, patients will complain of severe pain in the affected extremity with skin color changes, skin temperature fluctuations and muscle atrophy.

The exact pain mechanism is not clear, however it is thought to be secondary to dysregulation of both the central and autonomic nervous system.  This condition is often preceded by trauma or surgery to the involved limb.  People do express depression and anxiety that result after the occurrence of this syndrome.

This syndrome can occur secondary to peripheral nerve injury and/or after hemiplegia.

Potential symptoms that you may experience with this condition:

  • Symptoms first start at the site or injury and times tend to spread along the affected limb and at times transfer to the un-injured limb. Cross-over occurs in about 5% of patients.
  • Pain described as burning, stabbing and throbbing
  • Swollen leg or arm
  • Cold leg or arm
  • Skin sensitivity to touch
  • Stiff and swollen joints
  • Skin color changes with blotching
  • Skin becomes shiny and rubbery
  • Excessive sweating involving the affected limb

Treatment options for this condition:

  1. Immediate initiation of treatment is critical
  2. Physical therapy
  3. Occupational therapy
  4. Medications:
    1. Anti-inflammatory therapy
    2. Nerve pain medications: Neurontin, Lyrica, Amitriptyline, Nortriptyline
    3. Medications for anxiety and depression
    4. Muscle relaxants
  5. Cognitive behavioral therapy
  6. Interventions
    1. Lumbar sympathetic block for lower extremity CRPS
    2. Stellate Ganglion Block for upper extremity CRPS
    3. Spinal cord stimulator
    4. Intrathecal pain therapy
    5. Lidocaine infusion
    6. Ketamine infusion
    7. Botox injections
  7. Surgery: Sympathectomy