CRPS is usually associated with an injury, which can sometimes be as minor as a paper cut or small bruise. It causes nerves to misfire and send frequent or constant pain signals to the brain. The sympathetic nerves become overactive, causing intense burning or aching pain, along with swelling and changes in skin color, moisture, and temperature.
The most significant symptom of complex regional pain syndrome is severe burning pain, which is usually constant and occurs in areas other than the primary injury site. The pain is often out of proportion to the severity of the injury and lasts longer than expected for the type of injury. Swelling may be localized or involve the entire extremity. Abnormal hair and/or nail growth may occur. The skin is often warmer than in other areas, and it may appear shiny and thin and may exhibit increased sweating. The affected hand will have limited mobility. The symptoms vary in severity and length in each case.
There is no simple test to confirm a diagnosis of CRPS. Patients must be examined by a qualified physician who does a thorough history and physical examination. X-rays, bone scans, and thermography are sometimes helpful. A good response to a stellate ganglion block also supports a diagnosis of CRPS.
Consultation with other specialists may be needed, and often a pain clinic is recommended.
The earlier that the diagnosis of complex regional pain syndrome is made and treatment started, the better the chance of full recovery. The treatment is varied and depends on both the severity of the symptoms and the duration of the problem.
Some patients may have a chronic physical problem, such as an irritated nerve, that needs to be addressed to help with the pain. Since there is no simple cure for reflex sympathetic dystrophy, treatment is intended to relieve painful symptoms so that patients can resume their normal lives as well as continue to use the hand or extremity as much as possible.
Any of the following may be employed to treat complex regional pain syndrome, often in combination:
RSD Therapy
An exercise program to help with motion may help preserve or restore mobility and function to the affected hand.
Psychotherapy
Reflex sympathetic dystrophy may have profound psychological effects on patients and their families. Many with this chronic pain syndrome suffer from depression, anxiety, or post-traumatic stress disorder.
Sympathetic Nerve Blocks
Many patients experience significant relief from nerve blocks, in which local anesthetic is injected to numb the stellate ganglion, a cluster of sympathetic nerves at the base of the neck. By relieving pain, blocks can enable more effective therapy.
Medications
Many different drugs are used to treat reflex sympathetic dystrophy, including topical analgesics, anti-seizure drugs, antidepressants, corticosteroids, and opiods.
RSD Surgery
If the complex regional pain syndrome is due to a compressed nerve, such as with carpal tunnel syndrome, then surgery to release pressure on the nerve may be needed (i.e. carpal tunnel release).
Occasionally an operation known as sympathectomy is used to divide the sympathetic nerves in patients who are helped by nerve blocks, but its use is controversial.
Other options include spinal cord stimulation and intrathecal drug pumps, in which pain medications are injected continuously into the space around the spinal cord.
Each patient with RSD responds differently to treatment. Spontaneous remission occurs in some people. Others may have crippling irreversible changes in spite of appropriate treatment.
More research is needed to understand the causes, the development of the disease, and how treatment can alter its course. However, most physicians believe that early treatment is helpful to limit the disability from reflex sympathetic dystrophy.
If you believe you may have complex regional pain syndrome, make an appointment to see our hand surgeon in Howell, Macomb Township, Warren, or West Bloomfield.
