Complex regional pain syndrome (CRPS) is a chronic pain condition that can affect any area of the body, but often affects an arm or a leg.
CRPS; RSDS; Causalgia - RSD; Shoulder-hand syndrome; Reflex sympathetic dystrophy syndrome; Sudeck's atrophy
Doctors aren't sure what causes CRPS. In some cases, the sympathetic nervous system plays an important role in the pain. Another theory is that CRPS is caused by a triggering of the immune response, which leads to the inflammatory symptoms of redness, warmth, and swelling in the affected area.
CRPS has two forms:
CRPS is thought to result from damage to the nervous system, including the nerves that control the blood vessels and sweat glands.
The damaged nerves are no longer able to properly control blood flow, feeling (sensation), and temperature to the affected area. This leads to medical problems in the:
Possible causes of CRPS:
Rarely, sudden illnesses such as a heart attack or stroke can cause CSPS. The condition can sometimes appear without obvious injury to the affected limb.
This condition is more common in people ages 40 - 60, but it has been seen in younger people too.
The key symptom is pain that:
In most cases, CRPS has three stages. However, CRPS does not always follow this pattern. Some people develop severe symptoms almost right away. Others stay in the first stage.
Stage 1 (lasts 1 - 3 months):
Stage 2 (lasts 3 - 6 months):
Stage 3 (irreversible changes can be seen)
If pain and other symptoms are severe or long-lasting, many people may experience depression or anxiety.
Diagnosing CRPS can be difficult, but early diagnosis is very important.
The doctor will take a medical history and do a physical examination. Other tests may include:
There is no cure for CRPS, but the disease can be slowed. The main focus is on relieving the symptoms and helping people with this syndrome live as normal a life as possible.
Physical and occupational therapy should be started as early as possible. Starting an exercise program and learning to keep joints and muscles moving may prevent the disease from getting worse and help you perform everyday activities.
Medications may be used, including pain medicines, steroids, certain blood pressure medicines, bone loss medications (such as bisphosphonates like Fosamax and Actonel), and antidepressants.
Some type of talk therapy, such as cognitive behavioral therapy or psychotherapy, can help teach the skills you need to live with chronic pain.
Surgical or invasive techniques that may be tried:
The outlook is better with an early diagnosis. If the doctor diagnoses the condition within the first stage, sometimes signs of the disease may disappear (remission) and normal movement is possible.
If the condition is not diagnosed quickly, changes to the bone and muscle may get worse and may not be reversible.
In some people, symptoms go away on their own. In other people, even with treatment the pain continues and the condition causes crippling, irreversible changes.
Complications can also occur with some of the nerve and surgical treatments.
Contact your health care provider if you develop constant, burning pain in an arm, leg, hand, or foot.
There is no known prevention at this time. Early treatment is the key to slowing the progression of the disease.
National Institute of Neurological Disorders and Stroke. Complex regional pain syndrome fact sheet. Updated December 21, 2009. Accessed January 19, 2010.
Saxton DL, Lindenfeld TN. Complications. In: DeLee JC, Drez D Jr., Miller MD, eds. DeLee and Drez's Orthopaedic Sports Medicine. 3rd ed. Philadelphia, Pa: Saunders Elsevier;2009:chap 7.