Complex regional pain syndrome (CRPS) has no single cure, because no one treatment works for everyone. Most people with CRPS do recover, though recovery takes months and sometimes years.
CRPS may occur anywhere in the body, but it is more likely to affect limbs. There are two kinds of CRPS. CRPS-1 occurs secondary to some physical injury or illness causing nerve injury. CRPS-2 occurs due to damage to a specific nerve.
The condition is not just painful. It is also hard to diagnose, because in most cases there is pain with no signs of inflammation. It also makes the skin warmer in that area. But many people may have what is called cold CRPS.
The issue with the condition is that it causes severe pain in many without any visible injury. Other symptoms like swelling, redness, and local warmth may be present. Further, symptoms tend to change over time.
Most people will develop short-term CRPS lasting for a few months, and most will recover within a year. However, for some individuals, it is a cause for constant or chronic pain. It appears that young adults are more likely to recover faster from the condition. In contrast, older adults may need regular treatment for their pain.
Identifying CRPS
CRPS has different symptoms in different people. Often, the pain starts suddenly. It may be constant, or it may get worse with activity. It may feel like burning or “pins and needles.” Some people also feel “mirror pain,” in the same spot on the other side, which may mean spinal nerve cells are involved.
The pain often lasts a long time, and people with the condition are very sensitive to pain. They have what is called allodynia. That means in many cases, even a light touch can cause severe pain.
Other symptoms are changes in skin temperature and color, and swelling of the affected arm or leg.
More serious changes can happen too. Many people lose bone thickness, while others grow too much bone, which shows up on X-rays.
Over time, CRPS can also weaken the muscles, because people with the condition tend to move less.
CRPS can happen to anyone. But it is more likely in women and in people over 40. It is also more likely after fractures, surgery, sprains and strains, burns, cuts and so on.
Treatment Options
Diagnosing the condition is a bit tricky. But doctors or chronic pain specialists can often spot it from its typical signs. These include odd pain feelings and changes in skin color and temperature.
Complex Regional Pain Syndrome (CRPS) is best managed early. Since there are no treatment guidelines, doctors often need to combine several methods to beat it. People respond differently to different treatments.
Physical therapy and rehab are the core of treatment. Keeping the affected limb moving is key. It boosts blood flow, eases symptoms, and keeps the limb flexible, strong and working.
Also, wearing compression garments can significantly reduce swelling, especially when you stand. These simple habits are key to managing CRPS symptoms.
Psychotherapy (talk therapy) is another key part of CRPS treatment. Mental health problems like depression, anxiety and PTSD are common in these patients, and they can make pain worse.
Managing drugs is also a key part of CRPS treatment. No drugs are FDA-approved just for CRPS, but many drugs can help manage symptoms. Acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) are often used to ease pain and inflammation. Drugs for nerve pain, such as nortriptyline, gabapentin, pregabalin and duloxetine, can work well. So can skin treatments like lidocaine and fentanyl patches.
In more severe cases, doctors may consider bisphosphonates for bone changes, steroids for inflammation, opioids for extreme pain, and botulinum toxin shots to relax muscles.
Doctors may need advanced methods, such as spinal cord stimulation. This places small wires near the spine to block pain signals. Other nerve stimulation methods, like transcranial magnetic stimulation (rTMS) and deep brain stimulation, offer more options for managing CRPS pain. Spinal-fluid drug pumps send pain medicine right to the spinal cord. That is another advanced option. It cuts side effects in the rest of the body and makes the drug work better.
To summarize, CRPS may be challenging to treat, but a cure is possible. Most would recover within the year. Few might need longer medical care.
Dr. Gurpreet Singh Padda, MD, MBA, MHP
