Complex Regional Pain Syndrome

Complex regional pain syndrome is a chronic pain that affects limbs after injury, surgery, a stroke, or heart attack. Neuropathic pain plagues many individuals and can be attributed to postherpetic nerualgia, complex regional pain syndrome, cancer, phantom limb pain, neuroma, trigeminal neuralgia, etrapment neuropathy, peripheral neuropathy seconday to diabetes and alcohol, myelopathy secondary to trauma, and HIV. Pharmacotherapy for neuropathic pain includes SNRIs like venlafaxine or duloxetine, TCAs like amitriptyline, doxepin, desipramine, nortriptyline, sympatholytics xclonidine AEDS gabapentin, pregabalin, topiramate, carbamazepine, oxcarbazepine, anesthetics like lidocaine, and corticosteroids.

 Rare (Fewer than 200,000 cases per year in US)

"The treatment of neuropathic pain can be complex and multifactorial.  In my practice I work with each individual patient to establish a plan to effectively treat their individual pain."

  • NMDA Receptor antagonists
  • Ketamine
  • Memantinine Namenda
  • Amantadine
  • Methadone

Complex Regional Pain Syndrome

Treatment

Treatment from medical professional is advised and often requires lab test or imaging.


Can last several months or years and symptoms can include:

  • Continuous and throbbing pain
  • Sensation of burning and stinging
  • Sensitivity to heat or cold
  • Swelling
  • Changes in skin temperature — sweaty or cold at times
  • Changes in skin texture, which may become tender, thin or shiny in the affected area
  • Hair and nail changes
  • Joint stiffness
  • Tremors and muscle spasms
  • Atrophy of muscles
  • Osteoporosis
  • Reduced mobility of the affected area

Common tests & procedures

Physical examination : The doctor observes the site of pain for changes in the skin color, texture, and temperature. They will also examine the mobility of limbs.


Nerve conduction test : To measure the electrical activity of nerves. Abnormal readings indicate nerve damage.


Bone scan : To detect the changes in the bone.


Thermography : To measure skin temperature at different parts of the body. CPRS patients show abnormally high, or abnormally low temperatures in the affected areas.


There's no known cure for complex regional pain syndrome (CRPS), but a combination of physical therapies, medication, and psychological support can help manage the symptoms.

Medications

Nonsteroidal anti-inflammatory drugs (NSAIDs): To control pain and inflammation.


Aspirin . Ibuprofen . Naproxen


Anticonvulsants: Prescribed to treat pain that is caused due to nerve damage.


Gabapentin Corticosteroids: Reduce inflammation and improve mobility in the affected limb. 

Prednisone


Bisphosphonates: It reduces the risk of bone loss. 

Alendronate . Pamidronate


Sympathetic nerve-blocking medication: Injection of an anesthetic to block pain fibers in your affected nerves may relieve pain in some people.


Bupivacaine . Epinephrine

Therapy

Physical therapy: Improves muscle strength.


Self-care

Apply cold packs.

Use topical analgesics.

Use capsaicin cream or lidocaine patches: these reduce hypersensitivity.

 

Patients suffering from Complex Regional Pain Syndrome are difficult to treat and they suffer significantly. Spinal Cord Stimulators and Dorsal Root Ganglion Stimulators have been implanted to help neuromodulate the pain and have proven to be quite effective.