Utah Complex Regional Pain Syndrome & Treatment


What is complex regional pain syndrome? 


Complex regional pain syndrome (CRPS) is a chronic pain and sensory condition that usually affects the limbs. It has been known as reflex sympathetic dystrophy (RSD), causalgia, Sudeck's atrophy, shoulder-hand syndrome, neuroalgodystrophy, and reflex neurovascular dystrophy. Although it affects women more often, men can also be diagnosed with CRPS. It is most common in those between the ages of 40-60.

Diagnosis


Diagnosis of CRPS has been troublesome over the years because of the high number of potential symptoms. At a consensus workshop in Orlando, Florida in 1994, the International Association for the Study of Pain Criteria coined the term "complex regional pain syndrome" and gave a new diagnostic criterion, but publication was sporadic and several doctors still diagnosed based on their own clinical experience. Then in 2003, several CRPS specialists met in Budapest, Hungary and came up with new diagnostic criteria that have become more widely accepted. These are known as the "Budapest diagnostic criteria for CRPS." The Budapest criteria have four categories. A patient must have at least one symptom in all four categories to be diagnosed with CRPS. The categories are:

 

1) Continual pain, which is disproportionate to any inciting event

2) At least one symptom in 3 of the 4 following categories:

- Sensory: Hyperesthesia and/or Allodynia

- Vasomotor: Temperature asymmetry and/or skin color changes and/or skin color asymmetry

- Sudomotor/Edema: Edema and/or sweating changes and/or sweating asymmetry

- Motor/Trophic: Decreased range of motion and/or motor dysfunction (weakness, tremor, dystonia) and/or trophic changes (hair, nail, skin)

3) Must display at least one sign at time of evaluation in two or more of the following categories:

- Sensory: Hyperalgesia (to pinprick) and/or Allodynia (to light touch and/or deep somatic pressure and/or joint movement)

Vasomotor: Temperature asymmetry and/or skin color changes and/or asymmetry

- Sudomotor/Edema: Edema and/or sweating changes and/or sweating asymmetry

Motor/Tropic: Decreased range of motion and/or motor dysfunction (weakness, tremor, dystonia) and/or trophic changes (hair, nail, skin)

4) There is no other diagnosis that better explains the signs and symptoms

 

Allodynia is a condition where pain is caused by a stimulus that would otherwise be a non-painful sensation (brushing by someone, for example). Hyperalgesia is when a normally painful stimulus becomes much more painful than would normally occur. These are thought to involve both the central nervous system (CNS) and the peripheral nervous system (PNS). There are two types of complex regional pain syndrome that affect different people. The first and more common type is type I and involves persistent pain and swelling in areas that have sustained trauma and produces vasomotor disorders. Type II is a result of a specific nerve injury.


Utah CRPS Treatment


Complex regional pain syndrome is a relatively rare disease that can greatly affect a person's lifestyle. Those who suspect that they may be suffering from CRPS should be evaluated as soon as possible. There are a number of options that the doctor will discuss with a patient if CRPS is diagnosed. Some possible options a doctor might consider are:

Spinal Cord Stimulation- Tiny electrodes are placed in the epidural space next to the spine. Small amounts of electrical current are delivered to the nerves to block pain signals traveling to the brain.

Infusion Techniques- A small catheter is placed through a needle into the epidural space next to the spine. Local anesthetic and other medications, such as steroids, are injected into the epidural space to relieve pain. A number of injections can prolong the pain-relieving effects.

Ketamine Infusion Therapy- Because the pain caused by CRPS tends to resist narcotic/opioid medication, a ketamine infusion is often a viable solution. Ketamine causes a disassociation between the thalamus and the limbic systems to put the patient into what is often described as a "dreamlike" state. The doctor will likely administer a low dose of Midazolam (Versed) in order to reduce the likelihood of hallucinations in patients.

Sympathetic Nerve Blocks- Medication is injected at the origin of the sympathetic nerves. When CRPS is affecting the head or upper extremities, a stellate ganglion block or brachial plexus nerve block will be preformed. If the lower extremities are affected, a lumbar sympathetic nerve block is performed.

Peripheral Nerve Stimulation- Much like spinal cord stimulation, peripheral nerve stimulation involves electrodes being placed next to the affected nerves to interrupt their signals with a minor electrical current.

Physical Therapy- Physical therapy is most often used in conjunction with other treatment options. Physical therapy will help a patient maintain or increase range of motion by exercising affected limbs.

Medical management- a number of medications can be helpful in controlling pain and symptoms involved with CRPS. These include NSAIDs, membrane-stabilizing drugs, and opioid medications.

Biofeedback- During this treatment, a patient will learn to become more aware of his or her body and its functions. When a patient can control otherwise involuntary actions, pain relief is often achieved.

For more information on how Omega Interventional Pain can help treat complex regional pain syndrome, please contact us at 801-261-4988, fill out our contact form or stop by our offices in Salt Lake City, Utah.