Complex Regional Pain Syndrome (CRPS) is a chronic pain condition resulting from dysfunction in the central or peripheral nervous system. It is characterised by severe and persistent neuropathic pain that is disproportionate to the initial injury.
Symptoms:
– Severe, burning, or throbbing pain.
– Increased sensitivity to touch or cold (allodynia) in the affected area.
– The skin over the affected region may appear shiny, thin, or dry.
– The affected limb may feel warmer or cooler than the unaffected one.
– Altered skin colour: red, blue, or blotchy in the affected area.
– Persistent swelling in the affected region.
– Stiffness and reduced range of motion in the involved joints.
– Muscle weakness or atrophy in the affected limb.
– Increased or decreased hair and nail growth on the affected limb.
– Difficulty using the affected limb due to pain or weakness.
Causes:
The precise cause of CRPS remains unclear, but it may involve:
– Abnormal nerve signalling
– Immune system response causing inflammation
– Injuries: sprains, fractures, surgery, or minor injuries can trigger CRPS.
Assessment and Diagnosis:
To effectively understand and treat CRPS, a thorough evaluation is essential for identifying the underlying cause. This includes the following components:
- A comprehensive history and assessment are vital
- Investigations: MRI, X-ray, CT scan, Bone scans
- Sympathetic nerve blocks: for diagnosis
- Follow-up for a personalised multimodal management plan
- Review of the agreed-tailored pathway outcomes
Multimodal Treatment:
The cornerstone of the treatment is the management of symptoms and the functional restoration of the affected area. It includes the following:
– Initiating oral analgesics, such as anti-neuropathic medication
– Topical treatments: Lidocaine or Capsaicin patches for localised neuropathic pain
– Physiotherapy for the functional restoration of joints
– Sympathetic nerve blocks (Lumbar, Stellate ganglion)
– Psychological support: stress management, cognitive behavioural therapy (CBT)
– Spinal cord stimulation: an implanted device for modulating pain signals
