Understanding Complex Regional Pain Syndrome

If you’re suffering from severe, chronic pain after you’ve had a stroke, heart attack, injury or surgery, it might be complex regional pain syndrome (CRPS). The pain can show up anywhere on your body, but typically affects an arm, hand, leg or foot.

The syndrome can be challenging to diagnose, with no single test available to confirm it or rule it out. This can be extremely frustrating if you are battling debilitating pain while seeking an accurate diagnosis and treatment. Further complicating the CRPS picture is that quicker treatment generally delivers better outcomes.

Clues You Might Have CRPS

Symptoms will vary from person to person. They can be constant, intermittent or may become worse when the affected body part is touched – even slightly. Symptoms include:

• Pain that is sudden or appears with no cause. This could feel like a burning, squeezing or pins-and-needle sensation. Over time, the pain may spread and, in rare instances, be mirrored in the opposite limb.
• Long-lasting or intense pain after use. The standard limb pain may spike and last long after you use the limb. And even light touch can spark new pain levels.
• Skin changes. The skin in the affected area can change color (purple, blue, gray or red), become swollen or alter its texture, becoming shiny and thin or thick and scaly.
• Changes in nail growth. The nails on the affected limb may grow faster or slower than your unaffected limbs.
• Stiff joints. Over time, it may become more difficult to move your affected limb, because of the pain and stiffness from lack of use.
• Weakened muscles. When you aren’t able to move your muscles as much as you once did, they can deteriorate.

How CRPS Is Diagnosed

Diagnosing CRPS starts with a physical examination and exploration of your medical history – particularly any recent injuries, surgeries or traumas. It’s possible that the affected area wasn’t involved in the medical event.

Your doctor may also order tests, including X-rays, magnetic resonance imaging (MRI), bone scans or sweat production tests, which can detect a difference in sweat production from one limb to the other.

Injections may also be used, both as a treatment and diagnostic tool when your doctor suspects a particular nerve or bundle of nerves. If the treatment offers relief, it also helps to confirm the diagnosis.

Steps To Easing Your Pain

Early in the diagnosis process, it is common to try physical therapy to see if movement can improve blood flow and reduce symptoms. Exercise can also help maintain flexibility, strength and function. Behavioral changes – keeping the affected limb elevated – may provide some relief along with wearing compression stockings or sleeves.

But you might need more aggressive treatment approaches. Those include:

• Medications. Doctors use a wide range of medications, starting with over-the-counter pain relievers such as ibuprofen, aspirin or naproxen sodium. If something stronger is needed, your doctor may consider prescription-based pain relievers.
• Antidepressants and anticonvulsants may be used to treat pain coming from a damaged nerve. And steroids may help to reduce inflammation and improve your mobility. In some cases, bone loss medications may be used to stop or slow bone loss.
• Injections. The troublesome nerve can be targeted with a sympathetic nerve block. Injected near the nerve (in the neck for upper extremities or in the lower back for lower extremities), this combination of numbing medication and steroid attempts to reset those nerves and turn off the pain signals. These repeatable injections often provide relief for several months at a time, though that can vary.
• Spinal cord simulator. If the relief provided by injections is short-lived, the next step is a spinal cord stimulator. The device, which is implanted in your body, uses a mild electrical current to scramble pain signals that are traveling along your spine. The system is comprised of two parts – a pulse generator and leads (tiny wires). The leads are placed along your spine, while the generator is implanted under the skin, around belt level. The implantation procedure involves two small incisions in the back and usually takes less than two hours. You’ll probably go home the same day. Batteries for the generator will need to be swapped out after about 10 years.

If you are dealing with complex regional pain syndrome, don’t give up. The important thing is to get a clear diagnosis. Once you have that, you can expect to receive pain relief through medication, injections or a spinal cord stimulator.