Complex Regional Pain Syndrome Type 1

 

Complex Regional Pain Syndrome, often referred to as CRPS, is a medical condition whereby the affected individual experiences severe pain in one or more limb. Complex Regional Pain Syndrome pain is typically described as being more intense than what would be expected for the inciting injury or stimuli. To date, the pathophysiology of Complex Regional Pain Syndrome is not well understood although studies have managed to identify two forms of the medical condition. The first is called Complex Regional Pain Syndrome Type 1 which is the most common form of the medical condition reported in patients. The other is Complex Regional Pain Syndrome Type 2, a rarer form of the condition distinguished from the aforementioned by the presence of distinct nerve damage.

Complex Regional Pain Syndrome Type 1

Complex Regional Pain Syndrome Type 1 and Type 2 can also be distinguished by the fact that the former normally occurs after an initial noxious event. Other than this and the nerve damage mentioned in association with the development of Complex Regional Pain Syndrome Type 2, there’s hardly any difference between Complex Regional Pain Syndrome Type 1 versus Type 2. Reflex Sympathetic Dystrophy (RSD) is an old term used for Complex Regional Pain Syndrome Type 1 and some literature may still refer to the medical condition as RSD.

Doctors, health insurance companies, and public health agencies also define Complex Regional Pain Syndrome Type 1 by alpha-numeric codes under the International Statistical Classification of Diseases and Related Health Problems, or ICD for short. ICD-10 is the 10th revision of the list. ICD-10 codes can also give information regarding the body site where the medical condition occurs, severity of the problem, and cause of the injury—among other things.

Complex Regional Pain Syndrome Type 1 ICD-10 codes specify which limb is affected. Some examples of Complex Regional Pain Syndrome Type 1 ICD-10 codes are G90.51 for Complex regional Pain Syndrome Type 1 occurring in the upper limb and G90.59 if the condition occurs in some other specified site. The latter code is usually reserved for those rare cases of Complex Regional Pain Syndrome where it develops in other pats of the body besides the limbs.

What Causes Complex Regional Pain Syndrome Type 1?

As previously mentioned, Complex Regional Pain Syndrome Type 1 usually develops following an initial noxious event resulting in varying degrees of tissue injury.  Some examples of such events include infections, sprains, surgery, nerve pressure, stroke, heart attack, immobilisation, and radiation therapy.

It may be difficult to determine the actual cause of Complex Regional Pain Syndrome Type 1 in some patients and sometimes, more than a single noxious event may lead to the development of the disorder. In fact, some individuals with the injuries mentioned above may not end up with the Complex Regional Pain Syndrome Type 1 disorder at all, and studies have not yet been able to determine why that is. To determine the occurrence of Complex Regional Pain Syndrome Type 1 in a patient, an examiner would have to take note of their signs and symptoms and use a diagnostic checklist to compare them with those expected in Complex Regional Pain Syndrome Type 1 patients. Other conditions which may present the same signs and symptoms will also have to be tested for and ruled out before a Complex Regional Pain Syndrome Type 1 diagnosis is given.

Signs and Symptoms in Complex Regional Pain Syndrome Type 1 Patients

The first thing that would point to the presence of Complex Pain Regional Syndrome Type 1 in a patient is severe pain that’s more intense than the inciting injury and lasts longer than what is considered normal for said injury. The criteria used to determine whether or not a patient has Complex Regional Pain Syndrome is called the Budapest Criteria which helps with making a clinical diagnosis of the disorder. The Budapest Criteria is basically a guideline in the form of a checklist with the common Complex Regional Pain Syndrome signs and symptoms listed under the categories sensory, vasomotor, sudomotor, and motor. The Budapest Criteria also stipulates that any medical conditions with similar signs and/or symptoms must be checked for and ruled out before a diagnosis is made.

Even though there’s no established medical procedure for the diagnosis of Complex Regional Pain Syndrome Type 1; medical tests such as X-rays, MRI scans, thermography, and bone scans can help rule out other medical conditions. Once a Complex Regional Pain Syndrome Type 1 diagnosis has been made, early treatment is recommended for better management of the medical condition.

How Is Complex Regional Pain Syndrome Type 1 Treated?

In some patients, Complex Regional Pain Syndrome Type 1 has been said to disappear after two years from the time of onset. However, this is a long time and a great risk for someone to suffer through severe pain with the hope that it will some day stop on its own. The delay in treatment can also make it difficult to manage the condition, leaving the patient in the unrelenting pain. Even though there is currently no cure for Complex Regional Pain Syndrome Type 1, some patients have been seen to improve vastly through treatments that combine medications, physiotherapy, and psychotherapy.

The medicinal treatments used involve the use of various types of drugs mostly targeted at offering relief from Complex Regional Pain Syndrome Type 1 pain. Physiotherapy works hand-in-hand with the medications to increase the patient’s pain threshold and improve functionality of the affected limb through the use of gentle exercises. Because of the severe pain that affected individuals experience and the resulting increased dependency on caregivers, Complex Regional Pain Syndrome Type 1 patients are often depressed and anxious. This is where psychotherapy comes in. Therapies such as cognitive behavioural therapy and occupational therapy help those diagnosed with Complex Regional Pain Syndrome Type 1 manage their pain and learn new ways to perform their daily tasks so that they are not too dependent on their caregivers.

Neridronate Complex Regional Pain Syndrome Type 1 treatment

Among the many types of medications used for Complex Regional Pain Syndrome Type 1 treatment, Neridronate shows better long-term benefits when it comes to pain reduction and functional recovery. It is—so far—the only treatment designed specifically for Complex Regional Pain Syndrome treatment; made and approved for use in Italy. Despite the slight difference between Complex Regional Pain Syndrome Type 1 and Type 2, they are usually treated in the same way and that also applies to the Neridronate treatment.

Neridronate is a bisphosphonate, which is a class of molecules used for the treatment of bone cancer and osteoporosis. The efficacy of Neridronate in the treatment of Complex Regional Pain Syndrome was actually discovered when a patient was being treated for the above mentioned condition. The patient had also been suffering from Complex Regional Pain Syndrome and reported improved relief from the symptoms after the bisphosphonate treatment. This discovery led to years of further studies until Neridronate was created and patented for the treatment of rheumatic diseases, particularly the difficult to treat Complex Regional Pain Syndrome. It is worth noting that Doctor Adami made significant contributions towards the strides made in implementing Neridronate for Complex Regional Pain Syndrome treatment.

The efficacy of Neridronate for Complex Regional Pain Syndrome Type 1 treatment is partially reliant on the duration of the medical condition. Early Neridronate treatment is recommended for the best results, so it is best for a doctor to prescribe this treatment as soon as a Complex Regional Pain Syndrome diagnosis is confirmed after the onset of the first signs and symptoms. Some doctors in Italy believe that this is not entirely the case, and as long as a patient is still showing symptoms of Complex Regional Pain Syndrome then the medical condition will still be active and treatable using Neridronate, though the results may differ a little.

Bisphosphonates easily bond to calcium which is a major component of bones. As a result of the easy bondage between bisphosphonates and calcium, the former is easily incorporated by bones. Once the bisphosphonates bind to the surface of bones, they halt the breakdown of bones which is one of the common symptoms of Complex Regional Pain Syndrome Type 1. This mechanism gives a little insight into the workings of the Neridronate treatment.

Complex Regional Pain Syndrome patients are first evaluated to determine if they are eligible for Neridronate treatment. This is achieved by checking the patient’s clinical history and information about the treatments they’ve received so far, as well as other medical records such as any major dental work done 6 months prior, as one of the side effects of the treatment is jaw necrosis. Knowing the medications and other treatments that the patient is currently receiving is also important as some treatments—medical or otherwise—may not be compatible with Neridronate and may need to be stopped before the new treatment begins.

Once a patient is confirmed to be eligible and ready for Neridronate treatment, they are given 4 infusions of Neridronate in accordance with Dr. Adami’s original protocol. Neridronate can be administered intravenously or orally, although the oral method may lead to side effects such as jaw necrosis and irritation of the stomach and oesophagus. Physiotherapy to help with blood and circulation, as well as pain medications for pain relief are recommended along with Neridronate treatment during the 2 to 3 months it takes for the infusions to take full effect. Light Therapy, also known as Heliotherapy, is also recommended to complete the treatment.

A 97% rate of total remission has been reported, especially in patients still in the early stages of the disease. People who have been suffering from Complex Regional Pain Syndrome Type 1 for some time may experience varying levels of pain relief as each individual case is unique. As mentioned before, a few side effects may come from the use of Neridronate such as light flue-like symptoms, dizziness, and lower calcium or Vitamin D levels in the blood. The Light Therapy suggested above actually helps to remedy the issue of Vitamin D deficiency in patients receiving the Neridronate treatment.

Other medications used for Complex Regional Pain Syndrome Type 1 treatment

The other commonly used drugs for Complex Regional Pain Syndrome Type 1 pain relief include:

  • Analgesics
  • Anticonvulsants
  • Anaesthetics
  • Antidepressants
  • Oral Muscle Relaxants
  • Corticosteroids
  • Calcitonin
  • Opioids

The effectiveness of these drugs with respect to pain relief varies with each individual. Some may get the best results from using one or all of these, while other patients may experience worsening of their symptoms instead. This makes it difficult to treat the medical condition and it is best to evaluate the best treatment option for each patient on a case-by-case basis. Most of these offer short term relief, if any, and only Neridronate has been proven to give Complex Regional Pain Syndrome patients lasting relief from their symptoms.

Conclusion

True to its name, Complex Regional Pain Syndrome Type 1 is a complex medical condition. Research efforts continue to be made into understanding it and finding the best way to treat it. So far, the interdisciplinary approach seems to work for most patients. It is important that the patient communicates whether their symptoms get worse or better with any particular treatment so that adjustments can be made. Besides the types of treatments mentioned above, there are other methods for treating Complex Regional Pain Syndrome Type 1 that have been discovered. Some are natural remedies such as Epsom salt baths and heliotherapy. Others are controversial and considered unethical by some. Examples of these include surgical sympathectomy and amputation which most believe will only make the condition worse instead of treating it effectively. Increasing awareness of Complex Regional Pain Syndrome Type 1 contributes greatly to the discovery of new and better treatment options. A Complex Regional Pain Syndrome can return to their everyday life by managing their pain with medications and pursuing physical exercises to help restore limb function.

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