COMPLEX REGIONAL PAIN SYNDROME OR CRPS
Complex regional pain syndrome (CRPS) is a syndrome that occurs in a limb after a lesion, trauma or surgery.
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The affected body part appears swollen, red, hot or cold, and in pain. The pain gets worse over time and will gradually spread to neighbouring areas which initially had no pain. Often, only the touch of clothing will already trigger sudden spells of intense pain, similar to electric shocks. Trophic changes are also shown, with sweating or coldness of the affected area, accompanied by brittle nails. CRPS may ultimately lead to an overall reduction in movement in the affected arm or leg, which makes an early diagnosis vital so that treatment can be applied before the symptoms progress and the disease is fully developed.
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Patient with CRPS on his right hand |
CAUSES OF CRPS
CRPS seems to be a hypersensitive response of the sympathetic nervous system to an external noxious stimulus. It is typical of injuries involving peripheral nerves and is particularly common after gunshot wounds. CRPS also appears often after prolonged periods of immobilisation or repeated trauma.
TREATMENT OPTIONS
It is very important to start the treatment as soon as possible. For this purpose, a rehabilitation program must be organised under the supervision of a physiotherapist. Drugs that block nerve transmission or capsaicin-based creams may be administered. However, it is not always possible to achieve the complete disappearance of pain, and recovery of limb function is sometimes not satisfactory. If the CRPS does not respond to these therapies, one of the following can be tried:
- Sympathetic nervous system block. After temporarily blocking the blood supply to the affected limb, special drugs, which will block the excessive action of the nervous sympathetic system, are injected.
- Insertion of a neurostimulator to stimulate the posterior columns of the spinal cord.
- Sympathectomy. This is only carried out if the previous procedures have failed.