CRPS: Causes, Symptoms, Diagnosis, Treatment, and Prevention
CRPS is a chronic condition affecting the limbs, usually after an injury or surgery. It causes severe pain and other symptoms, including changes in skin color, temperature, and texture. CRPS is rare and its exact cause is unknown, but it is believed to be associated with an abnormal nervous system function.
Causes of CRPS
CRPS can be classified into two types, depending on whether there is nerve damage or not:
-
Type 1: This type occurs without nerve damage. It happens after an illness or injury that did not directly damage the nerves in the affected limb. About 90% of people with CRPS have type 1.
-
Type 2: This type occurs after known nerve damage. It has symptoms similar to type 1, but the pain is usually more severe and localized.
-
The exact mechanism of CRPS is not fully understood, but it is thought to involve a combination of factors, such as:
-
The injury or surgery may trigger an inflammatory response, which can result in swelling, redness, and warmth in the affected area. This may also affect the blood vessels and nerves, causing abnormal sensations and pain.
-
Affected nerves may become more sensitive to pain signals, even from normal stimuli, such as touch or cold. This can also affect the brain and spinal cord, altering blood flow and temperature regulation.
-
Some people with CRPS have higher levels of certain antibodies and inflammatory markers, and the immune system may interact with the nervous system and contribute to inflammation and pain.
Symptoms of CRPS
Pain is the main symptom of CRPS, and it may be constant, burning, or throbbing. It may spread to other parts of the limb or to the opposite limb. It may last for months or years, regardless of the severity of the initial injury.
Other symptoms of CRPS may include:
-
Sensitivity to touch or cold
-
Swelling of the affected area
-
Changes in skin color, ranging from white and blotchy to red or blue
-
Changes in skin temperature, alternating between sweaty and cold
-
Changes in skin texture, which may become tender, thin, or shiny
-
Changes in hair and nail growth
-
Joint stiffness, swelling, and damage
-
Muscle spasms, tremors, and weakness
CRPS symptoms can vary from person to person and may change over time. Sometimes, the symptoms will go away or improve on their own. Other times, the symptoms may persist or worsen, causing complications such as:
-
Loss of function and mobility of the affected limb
-
Muscle atrophy and bone loss
-
Psychological distress, such as depression, anxiety, and post-traumatic stress disorder
-
Spread of the condition to other parts of the body
Diagnosis of CRPS
To diagnose CRPS, no specific test is necessary. The diagnosis is based on the history, physical examination, and exclusion of other possible causes of the symptoms. Additionally, the doctor may use some criteria, such as the Budapest criteria. A Budapest criteria includes:
-
Having at least one symptom in each of the following categories: sensory, vasomotor, sudomotor/edema, and motor/trophic
-
Having at least one sign in at least two of the above categories
-
Having no other diagnosis that can better explain the symptoms and signs
The doctor may also order some tests, such as blood tests, X-rays, bone scans, nerve conduction studies, or thermography, to rule out other conditions and to assess the extent of the damage.
Treatment of CRPS
There is no cure for CRPS, but the treatment aims to relieve pain and improve function and quality of life. Early treatment is most effective, preferably within three months of the onset of symptoms. A combination of the following treatments may be used:
-
To treat pain and inflammation, the doctor may prescribe some medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, opioids, anticonvulsants, antidepressants, or local anesthetics. It is also possible to deliver some medications directly to the affected area or spinal cord by injecting, patching, or pumping them.
-
To help with movement, strength, and flexibility of the affected limb, a physical therapist may devise an exercise program. Exercises also help with blood circulation, temperature regulation, and pain reduction. The physical therapist may also use some techniques, such as massage, heat, cold, electrical stimulation, or ultrasound, to ease the symptoms and prevent complications.
-
As part of psychological therapy, the psychologist can offer counseling, education, and support to assist with the emotional and mental aspects of CRPS. As part of the pain management and adjustment to the condition, the psychologist may also teach coping skills, such as relaxation, distraction, or cognitive-behavioral therapy.
-
An interventional procedure is one that the doctor may perform to block or modify pain signals, such as nerve blocks, spinal cord stimulation, intrathecal drug delivery, or sympathectomy. Depending on the type and outcome of the procedure, these procedures may provide temporary or permanent relief.
-
Those who suffer from CRPS may benefit from alternative therapies, like acupuncture, biofeedback, hypnosis, or transcutaneous electrical nerve stimulation (TENS). It is important to use these therapies in conjunction with conventional treatments in order to reduce pain and stress.
Prevention of CRPS
There is no sure way to prevent CRPS, but some measures may help reduce the risk or the severity of the condition, such as:
-
Seeking prompt and proper treatment for any injury or surgery that may affect the limbs
-
Following the doctor's and the physical therapist's instructions for the recovery and rehabilitation of the affected limb
-
Taking good care of the skin, nails, and joints of the affected limb
-
Avoiding smoking, alcohol, caffeine, and other substances that may impair the blood flow and the nerve function
-
Managing the stress and the emotions that may worsen the pain and the symptoms
-
Seeking professional help if the pain and the symptoms persist or interfere with the daily activities and the well-being
