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Introduction to Complex regional pain syndrome (CRPS)
Complex regional pain syndrome (CRPS), also called reflex sympathetic dystrophy syndrome, is a chronic pain condition in which high levels of nerve impulses are sent to an affected site. Experts believe that CRPS occurs as a result of dysfunction in the central or peripheral nervous systems.
CRPS is most common in people aged 20-35. The syndrome also can occur in children; it affects women more often than men.
There is no cure for CRPS.
What Causes Complex Regional Pain Syndrome?
CRPS most likely does not have a single cause but rather results from multiple causes that produce similar symptoms. Some theories suggest that pain receptors in the affected part of the body become responsive to catecholamines, a group of nervous system messengers. In cases of injury-related CRPS, the syndrome may be caused by a triggering of the immune response which may lead to the inflammatory symptoms of redness, warmth, and swelling in the affected area. For this reason, it is believed that CRPS may represent a disruption of the healing process.
What Are the Symptoms of Complex Regional Pain Syndrome?
The symptoms of CRPS vary in their severity and length. One symptom of CRPS is continuous, intense pain that gets worse rather than better over time. If CRPS occurs after an injury, it may seem out of proportion to the severity of the injury. Even in cases involving an injury only to a finger or toe, pain can spread to include the entire arm or leg. In some cases, pain can even travel to the opposite extremity. Other symptoms of CRPS include:
- "Burning" pain
- Swelling and stiffness in affected joints
- Motor disability, with decreased ability to move the affected body part
- Changes in nail and hair growth patterns. There may be rapid hair growth or no hair growth.
- Skin changes. CRPS involves changes in skin temperature -- skin on one extremity can feel warmer or cooler compared to the opposite extremity. Skin color changes also are apparent as the skin is often blotchy, pale, purple or red. The texture of skin also can change, becoming shiny and thin. People with syndrome may have skin that sometimes is excessively sweaty.
- CRPS may be heightened by emotional stress.
How Is Complex Regional Pain Syndrome Diagnosed?
There is no specific diagnostic test for CRPS, but some testing can rule out other conditions. Triple-phase bone scans can be used to identify changes in the bone and in blood circulation. Some health care providers may apply a stimulus (for example, heat, touch, cold) to determine whether there is pain in a specific area.
Making a firm diagnosis of CRPS may be difficult early in the course of the disorder when symptoms are few or mild. CRPS is diagnosed primarily through observation of the following symptoms:
- The presence of an initial injury
- A higher-than-expected amount of pain from an injury
- A change in appearance of an affected area
- The presence of no other cause of pain or altered appearance
How Is Complex Regional Pain Syndrome Treated?
Since there is no cure for CRPS, the goal of treatment is to relieve painful symptoms associated with the disorder. Therapies used include psychotherapy, physical therapy, and drug treatment, such as topical analgesics, narcotics, corticosteroids, antidepressants and anti-seizure drugs.
Other treatments include:
- Sympathetic nerve blocks: These blocks, which are done in a variety of ways, can provide significant pain relief for some people. One kind of block involves placing an anesthetic next to the spine to directly block the sympathetic nerves.
- Surgical sympathectomy: This controversial technique destroys the nerves involved in CRPS. Some experts believe it has a favorable outcome, while others feel it makes CRPS worse. The technique should be considered only for people whose pain is dramatically but temporarily relieved by selective sympathetic blocks.
- Intrathecal drug pumps: Pumps and implanted catheters are used to send pain-relieving medication into the spinal fluid.
- Spinal cord stimulation: This technique, in which electrodes are placed next to the spinal cord, offers relief for many people with the condition.
Brain and Nervous System Resources
Edited by Ephraim K Brenman, DO on March 01, 2007
'Portions of this page © The Cleveland Clinic 2000-2005
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Chronic PainChronic pain is pain (an unpleasant sense of discomfort) that persists or progresses over a long period of time. In contrast to acute pain that arises suddenly in response to a specific injury and is usually treatable, chronic pain persists over time and is often resistant to medical treatments.
Codeine is a narcotic pain reliever (analgesic) used to treat mild to moderately severe pain. It is frequently combined with Tylenol or aspirin for more effective pain relief. Common side effects include:
- Stomach pain
- Shortness of breath
More serious adverse effects are severe low blood pressure, adrenal insufficiency, accidental ingestion of codeine, which can result in fatal overdose. Since codeine is a narcotic it has a potential for abuse. Patients with current or previous drug addiction problems should be monitored closely for addiction. Dependence and addiction can occur with codeine, even at prescribed dosages when taken over long periods. Misuse of codeine can lead to serious cardiac events and sudden death.
It is important to be aware of drug interactions, effects on pregnancy and nursing mothers, as well as common side effects on the user.
REFERENCE: FDA Prescribing Information for codeine.
Gabapentin (Neurontin, Gralise, Horizant, Fanatrex FusePag) is a drug prescribed for the treatment of seizure disorders, nerve damage from shingles and postherptic neuralgia. Off label uses of gabapentin include treatment for:
- Substance abuse withdrawal
- RLS (restless legs syndrome)
- Diabetic neuropathy
- Hot flashes
Common side effects include:
- Fluid retention (edema)
Adverse reactions and serious side effects include:
- Motion sickness
- Blurred vision
- Viral infection
Gabapentin is available as capsules as 100, 300, and 400 mg; tablets as 100, 300, 400, 600, and 800 mg; and as a solution of 250 mg/5 ml. The exact dosage depends upon the condition being treated. It is not known if this drug is safe to take during pregnancy. It is secreted in breast milk, so mothers who are breastfeeding should consult their OB/GYN or other health care professional and only use this gabapentin if the benefits outweigh the risks to the fetus. Gabapentin is not a narcotic (opioid), however, it does share signs and symptoms associated with drug abuse and addiction. Patients taking this drug may experience withdrawal symptoms like goosebumps, sweating, vomiting, and nausea. Gabapentin was approved by the FDA in 1993.
Hydromorphone hydrochloride, oral (Dilaudid, Dilaudid-5, Dilaudid-HP Injection, Exalgo) is an opioid narcotic pain reliever prescribed to manage acute and moderate to severe chronic pain. Common side effects are:
Drug interactions, dosage, and pregnancy and breastfeeding safety information should be reviewed prior to administering this medication.
Neuropathic Pain (Nerve Pain)Neuropathic pain is a chronic condition that leads to ongoing pain symptoms. Patients can be predisposed to developing neuropathic pain who have conditions such as:
- vitamin deficiencies,
- shingles, and
- multiple sclerosis.
Pain ManagementPain management and treatment can be simple or complex, according to its cause. There are two basic types of pain, nociceptive pain and neuropathic pain. Some causes of neuropathic pain include:
- complex regional pain syndrome,
- interstitial cystitis,
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prednisolonePrednisolone (Flo-Pred, Pediapred, Orapred, Orapred ODT) is a corticosteroid prescribed to achieve prompt suppression of inflammation due to inflammatory and allergic conditions (for example, rheumatoid arthritis, lupus, gout, ulcerative colitis, Crohn's disease, hay fever, types of dermatitis, and many others. Side effects, drug interactions, dosage, storage, and pregnancy safety information should be reviewed prior to taking this medication.
Prednisone is a drug that belongs to the corticosteroid drug class, and is an anti-inflammatory and immune system suppressant. It's used to treat a variety of diseases and conditions, for example: inflammatory bowel disease (Crohn's disease and ulcerative colitis), lupus, asthma, cancers, and several types of arthritis.
Common side effects are weight gain, headache, fluid retention, and muscle weakness. Other effects and adverse events include glaucoma, cataracts, obesity, facial hair growth, moon face, and growth retardation in children. This medicine also causes psychiatric problems, for example: depression, insomnia, mood swings, personality changes, and psychotic behavior. Serious side effects include reactions to diabetes drugs, infections, and necrosis of the hips and joints.
Corticosteroids like prednisone, have many drug interactions; examples include: estrogens, phenytoin (Dilantin), diuretics, warfarin (Coumadin, Jantoven), and diabetes drugs. Prednisone is available as tablets of 1, 2.5, 10, 20, and 50 mg; extended release tablets of 1, 2, and 5mg; and oral solution of 5mg/5ml. It's use during the first trimester of pregnancy may cause cleft palate. This medicine is secreted in breast milk and can cause side effects in infants who are nursing. You should not stop taking prednisone abruptly because it can cause withdrawal symptoms and adrenal failure. Talk with your doctor, pharmacist, or other medical professional if you have questions about beta-blockers. Talk with your doctor, pharmacist, or other medical professional if you have questions about prednisone.
If you notice other effects not listed above, contact your doctor or pharmacist. In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
Reflex Sympathetic Dystrophy SyndromeReflex sympathetic dystrophy syndrome (RSD) is a condition that features atypical symptoms including pain (often "burning" type), tenderness, and swelling of an extremity associated with varying degrees of sweating, warmth and/or coolness, flushing, discoloration, and shiny skin. RSD is also referred to as "the shoulder-hand syndrome." Treatment response is greater in earlier stages than later stages.