Complex Regional Pain Syndrome Symptoms

What is Complex Regional Pain Syndrome?

Complex Regional Pain Syndrome (CRPS) is a rare, chronic and usually progressive condition. The condition is characterised by spontaneous pain in a particular region of the body lasting for a period longer than six months. Complex Regional Pain Syndrome usually affects limbs like the arms, legs, hands or feet after one has experienced an injury in these areas. Complex Regional Pain Syndrome can also affect the back or the nerves. Although Complex Regional Pain Syndrome affects particular areas, the complications arising from the medical condition can eventually affect the whole body and can go as far as disabling the patient and affecting internal organs.

Complex Regional Pain Syndrome is categorised into two types, Complex Regional Pain Syndrome Type 1 and Complex Regional Pain Syndrome Type 2. Complex Regional Pain Syndrome Type 1 was previously known as Reflex Sympathetic Dystrophy Syndrome which affects individuals without confirmed nerve injury but usually from an initiating noxious occurrence or injury like a sprain or amputation. Complex Regional Pain Syndrome Type 1 symptoms spread from the site of injury gradually as it progresses. The patients are more likely to feel aching and burning in the legs and arms resulting in swelling.

Complex Regional Pain Syndrome Type 2 which was previously referred to as Causalgia comes after an associated and confirmed nerve injury. This is rarer than Type 1 and is usually felt on the extremities of limbs like hands, feet, arms and legs. The pain associated with Complex Regional Pain Syndrome type 2 is usually localised around the particular point where the damaged nerve is located. It is associated with a burning sensation in the affected area lasting over 6 months. The pain feels much more than expected with the associated injury.

Complex Regional Pain Syndrome shows signs of being an autoimmune condition. This is to say it causes the body’s immune system to attack healthy body cells perceiving them as a threat. This results in pain and inflammation in the area where this occurs. Complex Regional Pain Syndrome diagnosis is based mainly on the signs and symptoms. The challenge however is that the Complex Regional Pain Syndrome symptoms do not always show concurrently, making the diagnosis harder to make in a patient with the condition.

Complex Regional Pain Syndrome Symptoms

Complex Regional Pain Syndrome symptoms can vary in severity and duration in different patients, with the symptoms being mild and fading away in some cases. The Complex Regional Pain Syndrome symptoms can be characterised according to the changes they effect on the patient’s body. The four categories are detailed below:

  1. Sensory changes

Sensory changes are effects which affect sensitivity or feeling. As it has been established that pain is the prevalent symptom of Complex Regional Pain Syndrome patients, sensory changes cause the feeling. When one experiences an impact or injury on the body part where sensory changes occur, the sensory changes cause an excessive pain beyond what the injury would usually cause. The pain associated with Complex Regional Pain Syndrome usually feels like a mix of burning, stabbing or stinging which can also come with tingling or numbness. The pain can affect the whole limb, that is the arm or leg, whereas the related injury would have involved a finger or toe. There are rare cases where the pain travels to the opposite extremity. This excessive sensation of pain is caused by hyperalgesia which means an increase of sensitivity to pain.

In some patients the sensory changes from Complex Regional Pain Syndrome cause allodynia. Allydonia is a central pain sensitization which causes pain following a stimulation which is normally not painful like light touching and hair combing. Continuous throbbing pain without stimulation on the affected area can result from Complex Regional Pain Syndrome. The pain may come in periods lasting a few days or weeks in what are termed flare ups, where the pain increases.

Complex Regional Pain Syndrome Type 2 causes nerve lesion which is nerve damage to biological tissue affecting the sensitivity of the damaged part. This makes increase in sensitivity more common in Complex Regional Pain Syndrome Type 2 patients as a symptom.

Other Complex Regional Pain Syndrome symptoms related to sensory changes include spontaneous or evoked pain, mechanical, thermal and deep somatic hyperalgesia. Mechanical hyperalgesia is when one has a painful response to physical stimuli like a brush on the skin. Thermal hyperalgesia is altered perception to temperature where one has heightened sensitivity to noxious heat or cold. Another Complex Regional Pain Syndrome symptom is causing the affected area to swell up.

The Complex Regional Pain Syndrome affected limb can at times experience unusual sensations. These can feel as if the limb is not part of the rest of the body, or cause it to feel bigger or smaller than the opposite unaffected limb.

  1. Autonomic changes

Autonomic changes involve alteration to the autonomic nervous system. The autonomic nervous system relates to involuntarily controlled body functions like breathing, heartbeat and digestive functions. Complex Regional Pain Syndrome symptoms in relation to autonomic changes can include vasomotor and sudomotor changes. Vasomotor effects relate to constriction or dilatation of blood vessels while sudomotor changes relate to anything that stimulates the sweat glands. Complex Regional Pain Syndrome can cause vasodilation which is where blood vessels dilate decreasing blood pressure below normal levels. Vasoconstriction, the constriction of blood vessels causing increase in blood pressure can also be caused by Complex Regional Pain Syndrome.

Complex Regional Pain Syndrome can have symptoms of skin colour changes, skin temperature differences between affected and unaffected limbs, and abnormal sweating not related to heat or exercise which is called hyper/hypohydrosis . Oedema, a condition where the body retains fluid which builds up causing affected tissue to be swollen is another symptom.

  1. Trophic changes

With advancement of Complex Regional Pain Syndrome, trophic changes may be seen in the patient. Trophic changes are caused by nerve injuries resulting in alteration in skin texture, causing it to become tender, thin or shiny in the affected area. Atrophy of finger pulps, changes in nail beds, slowing or quickening of hair growth and slowing of skin healing after damage can be seen in Complex Regional Pain Syndrome patients. If Complex Regional Pain Syndrome has affected a particular limb in the body, that limb’s nails can grow slower or quickly relative to unaffected limbs. These nails can be seen to become brittle or grooved. Complex Regional Pain Syndrome can result in bone demineralisation causing osteoporosis. Osteoporosis is a disease which results in bone weakening increasing the risk of a broken bone. Skin on the affected area can turn red due to Complex Regional Pain Syndrome.

Complex Regional Pain Syndrome can cause the skin of the affected limb or body part to feel hot, red and dry at certain times while also feeling cold, blue and sweaty at other instances. This is caused by abnormal circulation of blood on a microscopic level due to the damage of nerves in the specific area responsible for blood flow and temperature.

Motor changes which affect a patient’s motor skills can be caused by Complex Regional Pain Syndrome. This is due to the excessiveness of the pain in a limb caused by Complex Regional Pain Syndrome which can cause the individual to fail to use this limb completely. If this failure to use the limb is prolonged, it will result in loss of calcium from the bones in the limb as well as muscle atrophy in that area. When muscle atrophy occurs, involuntary movements such as tremors and muscle spasms can occur in this limb. Complex Regional Pain Syndrome symptoms are thus expanded to include muscle weakness, tremor, dystonia which is involuntary muscle contractions, coordination deficits, joint stiffness and soft tissue.

Complex Regional Pain Syndrome symptoms also include mental health related issues. These result from the severity of the Complex Regional Pain Syndrome pain. This pain makes the patient experience anxiety, depression, post-traumatic stress disorder, and emotional stress. The emotional stress caused by the persistent pain can lead to flare ups. Headaches can also result from Complex Regional Pain Syndrome and insomniathe lack of sleep can affect Complex Regional Pain Syndrome patients. There are other rare Complex Regional Pain Syndrome symptoms such as:

  • Skin infections in the affected area
  • Open sores or ulcers
  • Muscle contractures which is when muscles shorten and their normal movement range is reduced
  • Muscle atrophy; which is the eroding or wasting away of the muscles.

How is Complex Regional Pain Syndrome diagnosed?

If you encounter some or a combination of these symptoms, it is important not to self diagnose but consult a qualified medical professional to perform a diagnosis as soon as possible. If Complex Regional Pain Syndrome has been diagnosed, one needs to seek treatment. There is currently no specific test to fully confirm Complex Regional Pain Syndrome so several criteria are used for the diagnostics. The criteria used to diagnose uses observations and symptoms reported by the patient. For example, with the symptom of increased sensitivity to pain; a test can be conducted for this increase in sensitivity using a pin prick, cotton wool, joint position, tuning fork, hot and cold roller, and other quantitative sensory tests.

Electrodiagnostic tests can be conducted to check for nerve damage. This helps diagnose patients with Complex Regional Pain Syndrome Type 2. The extent of the nerve damage is then determined through electromyography and nerve conduction tests. Magnetic resonance Imaging (MRI) scans capture the bone and tissue structure. With this scan a physician can check for irregularities in the tissue of the affected limb through the magnetic properties of the region affected. For the symptoms of temperature difference in the affected area, thermographic tests are used. The thermography test analyses differences in skin temperature and blood flow in limbs. This helps identify the limb affected by Complex Regional Pain Syndrome although the difference in skin temperature and blood flow can be caused by other factors. It is therefore a combination of factors used to diagnose Complex Regional Pain Syndrome.

 

Complex Regional Pain Syndrome Treatment

The treatments of Complex Regional Pain Syndrome target alleviating pain by treating or reducing the Complex Regional Pain Syndrome symptoms. Treatment methods are mainly in form of invasive and non-invasive therapies. Physical therapy can help treat Complex Regional Pain Syndrome patients by improving blood flow as well as recover movement and coordination in affected areas. Psychotherapy is a necessary treatment for the psychological effects like anxiety and depression. This is because if the psychological effects are ignored, rehabilitation and the recovery process with other treatment can be more difficult.

Several medications like non-steroidal anti-inflammatory drugs (NSAIDs), neridronate, oxygen radical scavengers such as dimethylsulphoxide, gabapentin, corticosteroids, calcium modulating drugs, anticonvulsants, antidepressants, and opioids have been used in the treatment of Complex Regional Pain Syndrome. These target to treat the Complex Regional Pain Syndrome symptoms like inflammation, reduce pain, and strengthen bones. In order to effectively treat Complex Regional Pain Syndrome, the medications are often used in combination with psychological interventions and physical rehabilitation programmes.

There are natural alternatives that can be used to treat and alleviate the pain associated with Complex Regional Pain Syndrome. These include:

  • Magnesium to relieve pain as it reduces the signals of pain that are transmitted to the brain. This only serves to relieve pain felt by the patient but does not treat the condition.
  • Vitamin C supplements aid in reducing inflammation in the area where swelling would have occurred. It also assists the healing process of wounds by neutralising free radicals and synthesising collagen.
  • Epsom salt, a naturally occurring mineral, aids in reducing inflammation and pain. Preparing an Epsom salt bath and soaking the affected area will provide a fast effect. The salts make the body eject harmful toxins and soothe aching parts. Epsom salts also have stress relieving properties and improve nutrient absorption.
  • Bone broth provides supplements of crucial elements like calcium, sulphur, magnesium and silicon. These assist in strengthening bones and relieving pain whilst reducing inflammation of the affected body pain.

There are other therapy methods and Complex Regional Pain Syndrome natural treatments which relieve pain and assist the body in healing without any chemicals involved. These include heat therapy, breathing exercises and meditation. Heat therapy helps with soothing the affected area and can be done in salt baths or infrared sauna, while breathing and meditation exercises relax the mind and reduce stress helping the patient with the pain of Complex Regional Pain Syndrome. There are particular foods that have been found to help in reducing inflammation associated with Complex Regional Pain Syndrome CRPS symptoms.

 

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