CRPS I

Complex Regional Pain Syndrome Type I (CRPS I)/Reflex Sympathetic Dystrophy (RSD)

Complex regional pain syndrome I (CRPS I) is a chronic disabling neurological disorder. CRPS I is also known as reflex sympathetic dystrophy (RSD).

CRPS I/RSD is characterized by severe burning pain, pathological changes in bone and skin, excessive sweating, swelling of tissue, and extreme sensitivity to touch.

The symptoms of CRPS I/RSD usually occur near the site of an injury. Symptoms can be either major or minor, and may include burning pain, muscle spasms, swelling, increased sweating, softening of bones, joint tenderness or stiffness, movement problems, and changes in the nails and skin. One visible sign of CRPS I/RSD near the site of injury is warm, shiny red skin that later becomes cool and bluish in color.

The pain that patients report is usually out of proportion to the severity of the original injury and gets worse, rather than better, over time. It is frequently characterized as a burning, aching, searing pain, which may initially be limited to the site of injury or the area covered by an injured nerve but spreads over time, often involving an entire limb. It can sometimes move (migrate) and involve other extremities. Pain is continuous and may be heightened by the emotional stress of dealing with this condition. Moving or touching the affected area is often intolerable. Eventually the joints can become stiff from disuse, and the skin, muscles, and bone atrophy.

The symptoms of CRPS I/RSD vary in severity and duration between individuals. However, there are usually three stages associated with the syndrome. Each stage is marked by progressive changes in the skin, nails, muscles, joints, ligaments and bones.

CRPS I/RSD Stage I. Stage one generally lasts from one to three months and is characterized by severe, burning pain at the site of the injury. Muscle spasm, joint stiffness, restricted mobility, rapid hair and nail growth, and a constriction of the blood vessels (vasospasm) that affects color and temperature of the skin can also occur.

CRPS I/RSD Stage II. In stage two, which typically lasts from 3 to 6 months, the pain intensifies. Swelling increases, hair growth diminishes, nails become cracked, brittle, grooved, and spotty, osteoporosis becomes severe and diffuse, joints thicken, and muscles atrophy.

CRPS I/RSD Stage III. As the patient reaches stage three, changes in the skin and bones become irreversible, and pain becomes persistent and may now involve the entire limb. There is marked muscle atrophy, severely limited mobility of the affected area, and contractions of the muscles and tendons that flex the joints. Occasionally the limb is displaced from its normal position, and bone softening is more dispersed.

The cause of CRPS I/RSD is unknown. It is thought to be the result of damaged nerves of the sympathetic nervous system -- the part of the nervous system responsible for controlling the diameter of blood vessels. These damaged nerves send signals to the brain, interfering with normal information about sensations, temperature and blood flow.

Since CRPS I/RSD is most often caused by trauma to the extremities, other conditions that can bring about CRPS I/RSD include sprains, fractures, surgery, damage to blood vessels or nerves, and cerebral lesions. CRPS I/RSD is unique in that it simultaneously affects the nerves, skin, muscles, blood vessels and bones.

CRPS I/RSD is often misdiagnosed because it remains poorly understood. Diagnosis is complicated by the fact that some patients improve without treatment. Delays in diagnosis and/or treatment for this syndrome can result in severe physical and psychological problems. Early diagnosis and prompt treatment provide the greatest opportunity for recovery.

CRPS I/RSD is diagnosed primarily through observation of the symptoms. However, some doctors may use thermography -- a diagnostic technique for measuring blood flow by determining the variations in heat emitted from the body to detect changes in body temperature that are common in CRPS I/RSD. An abnormal thermogram in a patient who complains of pain may lead to a diagnosis of CRPS I/RSD. X-rays can also show changes in the bone.

The treatment plan for CRPS I/RSD depends upon many factors, such as the severity of the disease, dysfunction and pain, the type and location of the pain, as well as patient’s age, ongoing medical conditions, and ability to tolerate other medical therapies. The doctor will take all of these factors into consideration when prescribing a treatment plan.

In general, the standard course of therapy will follow the chronic pain treatment continuum, and may include pain medications, exercise therapy, physical and occupational therapy, TENS, nerve blocks, surgery, neuromodulation, and neuroablation. Neurostimulation — particularly spinal cord stimulation — is an option for treating any unresolved neuropathic pain, which is common with CRPS I/RSD.