Complex Regional Pain Syndrome (CRPS)

The International Association for the Study of Pain (IASP) classifies this pain syndrome into two types. Type 1 (without nerve injury) is when a minor injury or a fracture precedes CRPS. Type 2 (nerve injury) develops after injury to a major nerve. CRPS typically affects an arm or leg and is more common in women than men. CRPS is a disorder of the central nervous system. CRPS

It isn't known why injuries such as a sprained ankle, surgery or heart attack precede CRPS but it may be a dysfunction between the central nervous system and the peripheral nervous system that causes pain which is more intense and described differently to the preceding injury.

Signs and symptoms are usually the same for Type 1 and Type 2 CRPS

Pain Symptoms

Visual signs

Movement changes

Other signs

Ongoing burning pain

Swelling Weakness

Changes in
skin temperature

Pain is more intense & differs
to the preceding
injury

Localised excessive or
lack of sweating

Coordination difficulty

osteoporosis
Allodynia Shiny, thin skin Tremor

Altered perception
of affected limb

Hypersensitivity Abnormal nail growth Muscle Spasms  

Feelings of freezing cold

Increased or decreased hair growth

Joint stiffness  

Spontaneous pain

Red or mottled skin    

(Note: These symptoms do not all need to be present for diagnosis)

CRPS is an uncommon condition which often leads to a delay in diagnosis. Health professionals may be unfamiliar with the signs and symptoms of the condition contributing to the difficulties in identifying the appropriate care needed.

Treatment

CRPS is debilitating with a complex pathology making it difficult to treat and a condition which is often resistant to general medical approaches. CRPS generally requires a multi-faceted therapeutic approach. If it is diagnosed and treated early (within the first few months) the treatment can be effective. Analgesia is important and may include anti-inflammatory medication, paracetamol and opioid based products. Anti-depressants and anticonvulsants may also be used to assist with the pain.

Sympathetic nerve blocks (injections of an anaesthetic agent) into the affected nerves to stop the pain signals in the affected limb. There are other injectable therapies which may be trialled by the pain specialists.

Physical therapy

Desensitization - "to hurt is not to harm". Over a period of time the person with CRPS will be encouraged to desensitize the affected limb so that the hypersensitivity and allodynia is reduced. For example, over a period of three years Annette, a CPRS patient, began with moving a silk scarf over her foot, progressed to being able to wear a foot stocking, to a sock, sandal and finally a closed in shoe for a short period. This process took three years but improvements are still being made.

Graded motor imagery (GMI) combined with medical management is recognized as being effective in reducing pain in CRPS. GMI involves encouraging the person to differentiate between left and right limbs to re-establish right and left concepts in the brain. Progressively, a mirror box is introduced. The person is asked to watch the mirrored image of the unaffected limb moving in the mirror. Then, the person moves the affected limb in the mirror box while watching the mirrored image of the unaffected limb. This tricks the brain into thinking it is seeing the limb with CRPS moving without pain.

 

ABOUT US

The Australian Pain Management Association Inc. (APMA) is a health promotion charity providing advocacy, information and practical support for people living with chronic (persistent) pain and their families. APMA is the consumer health organisation for all Australians who live with pain. APMA is your voice.

 

Contact Us

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1300 340 357

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Australian Pain Management Association Inc. (APMA)
Land Centre, 867 Main St Woolloongabba QLD 4102
GPO Box 2104, Brisbane 4001