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Beverly A. Whittenberg, MD
Treatments Vary For Complex Regional Pain Syndrome (CRPS)
National Spine & Pain Centers
. http://www.treatingpain.com

Treatments Vary For Complex Regional Pain Syndrome (CRPS)

Treatments Vary For Complex
l Pain Syndrome (CRPS)

Complex regional pain syndrome, also known as CRPS, is a condition of chronic pain that persists for no discernable reason. Its as if the affected nerves take on a mind of their own and refuse to take their normal cues from the brain. Sometimes CRPS results from an injury, trauma or some other obvious reason, but in other cases, there is no apparent cause.

Diagnosing CRPS

The key symptom of CRPS is continuous, often intense, pain which tends to get worse rather than better as time passes. It most often affects the extremities such as arms, legs, hands or feet but can occur at any point in the body.

Most of the time, CRPS is accompanied by changes in skin color and temperature. For example, while the unaffected arm is normal, the arm with CRPS feels warm to the touch. Other symptoms may include burning pain, skin sensitivity, changes in nail or hair growth patterns, swelling and stiffness in affected joints, and blotchy, purple, pale or red skin.

Although an individuals medical history and symptoms are important in the diagnosis of CRPS, imaging techniques, such as a triple-phase bone scan, are sometimes used to reveal changes in bone and blood circulation.

How is CRPS Treated?

Although there is no cure for CRPS, the pain is treated using a variety of methods.

Medications Appropriate medications to relieve pain include topical analgesic drugs, corticosteroids and other over-the-counter pain relief drugs. A clonidine patch may be prescribed for long-lasting pain relief.

Psychotherapy Because of the often intense and continuous pain, people with CRPS may benefit from the use of anti-depressants or anti-anxiety drugs that lessen the perception of pain that tend to prolong the rehabilitation process.

Sympathetic Nerve Block Some people with CRPS get significant relief using sympathetic nerve blocks either through the intravenous administration of drugs such as phentolamine or placement of an anesthetic next to the spine to directly block the sympathetic nerves.

Spinal Cord Stimulation A dorsal column simulator is a pain-relieving device that stimulates nerves using tiny electrical impulses administered through small electrical wires placed on the spinal cord.

Intrathecal Drug Pumps These devices administer drugs directly into the spinal fluid so that the dosages of pain-relieving medicines can be of lower dose than those given orally. This technique increases drug effectiveness and decrease potential side effects.

Three Stages of CRPS

CRPS is often divided into three stages, according to the symptoms.

Stage 1 Lasts from 1 – 3 months and is characterized by severe burning pain, muscle spasms, and changes in the blood vessels that cause alterations in skin temperature and color.

Stage 2 Last from 3 – 6 months and is characterized by intensifying pain, swelling, softened bones, and weak muscle tone.

Stage 3 More than six months as pain becomes unbearable and may spread to the entire limb or affected area. An individual with CRPS at this stage may have muscle loss, limited mobility, and muscle contortion. In this stage, changes to the skin and bone are irreversible.

CRPS is difficult to diagnose, but a trained specialist will be able to recognize symptoms and offer appropriate treatment and pain relief.


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