FAQ’s on Reflex Sympathetic Dystrophy (RSD) & Complex Regional Pain Syndrome in Philadelphia
Complex regional pain syndrome (CRPS) is a condition that affects an arm or a leg. This condition is the result of damage to the nervous system. The estimated incidence rate of CRPS is 26 per 100,000 persons.
What causes CRPS?
Also called reflex sympathetic dystrophy (RSD), CRPS affects the sympathetic nervous system. The sympathetic nerves control sweating and blood vessels. When the nerves are damaged, they no longer can properly control blood flow, sensation (feeling), or temperature. CRPS is caused from an injury to a nerve or from an infection of the leg or arm.
Who gets CRPS?
CRPS affects women slightly more than men, and it is most common among people 40 to 60 years of age.
What are the symptoms of complex regional pain syndrome?
The main symptom of CRPS is pain that is intense, of a burning quality, and stronger than it should be for the injury. In addition, symptoms include:
- Pain that worsens over time.
- Pain that starts at the point of injury and spreads to the entire limb or opposite side of the body.
What are the stages of CRPS?
There are three stages of CRPS, but the symptoms do not always follow the ‘usual’ pattern. The stages are:
- Stage 1 – This stage last 1-3 months and includes changes in skin temperature, muscle spasms, joint pain, increased hair/nail growth, burning pain, hypersensitivity, swelling, sweating, and skin color changes (red, blotchy, and/or purple).
- Stage 2 – This stage lasts 3-6 months. Symptoms include worsening pain, slow hair growth, cracked/broken nails, stiff joints, and muscle weakness.
- Stage 3 – This stage occurs after 4-9 months and involves limited limb movement due to contractures of the tendons and muscles, wasting of muscles, and continued pain.
How is CRPS diagnosed?
If the doctor suspects you have CRPS, he/she will order some diagnostic tests to evaluate temperature and blood flow to the affected limb. To rule out serious problems, bone scans, x-rays, and nerve conduction studies are done.
What are the treatment options for a person with CRPS?
There is no cure for CRPS, but treatment helps symptoms and slows disease progression. The aim of treatment is to relieve the associated symptoms. Options include:
- Therapy – Physical and occupational therapy will begin as soon as a diagnosis is made. The therapist uses an intense exercise program to keep the muscles and joints moving and prevent the disease from worsening.
- Medications – Various medications are used to treat pain, including antidepressants, anticonvulsants, anti-inflammatory drugs, calcitonin, and narcotic analgesics.
- Stellate ganglion block – With this procedure, the doctor inserts a special needle in the front of the neck using x-ray guidance. An anesthetic drug is injected onto the sympathetic nerves. According to a recent clinical study, this procedure had a 76% efficacy rate, with 50% of patients reporting total pain reduction.
- Sympathectomy – With this treatment, a neurolytic agent is used to destroy a portion of the sympathetic nerves. The doctor inserts a needle near the affected nerves using x-ray guidance. In a recent research study, this procedure had a 77% success rate.
- Intrathecal pump – A small device can be surgically implanted near the spinal cord to deliver medicine directly into the spinal fluid. This bypasses the gastrointestinal block so the patient does not experience side effects, such as nausea and vomiting.
- Spinal cord stimulation (SCS) – When the patient fails on other treatments, the doctor may choose to implant a spinal cord stimulator. This tiny device involves electrodes near the spinal cord that receive tiny electrical impulses, which blocks pain signal transmission. In a clinical study, researchers reported that SCS had a 71% efficacy rate.
Ackermann, WE & Zhang, JM (2004). Efficacy of stellate ganglion blockade for the management of type 1 complex regional pain syndrome. Southern Medical Journal, 1084-1088.
Bandyk, DF, Johnson, BL, Kirkpatrick, AF, Novotney, ML, et al. (2002). Surgical sympathectomy for reflex dystrophy syndromes. Journal of Vascular Surgery, 35(2), 269-277.
deMos M, De Bruijn AG, Huygen FJ, Dieleman JP, Stricker BH, & Sturkenboom MC (2007). The incidence of complex regional pain syndrome: a population-based study. Pain,129:12–20.
Geurts, JW, Smits, H, Kemler MA, Brunner, F., Kessels, AGH, & van Kleef, M (2013). Spinal Cord Stimulation for Complex Regional Pain SyndromeType I: A Prospective Cohort Study With Long-Term Follow-Up. Neuromodulation.