Complex Regional Pain Syndrome

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