What is the best diagnosis method for this debilitating condition?
Complex Regional Pain Syndrome is a chronic illness affecting a limb, following a triggering event such as surgery, fracture, broken bones or even a lighter injury like a sprain. It comes with a long list of symptoms, the main one being tremendous pain in the affected area. With up to 250.000 people suffering from it only in the United States of America, CRPS is still considered a “rare disease”. To this day there is no cure for the pathology; but, if caught up early, adapted treatment can lead the patient to living a normal life.
The issue with rare conditions is that the government provides minimal funding for cure-research and study of the disease itself. This also means some of those conditions do not have an official medical diagnosis test, which is the case for CRPS. Bringing us to one of the main issues with the pathology: getting a proper diagnosis in order to get a proper treatment.
There are few methods used to diagnose CRPS. For example, results to the following tests might give clues linking the patient’s symptoms to CRPS:
– Bone scan: This might help see some disturbances in the bones. For example, one of the symptoms of CRPS being bone edema, it could easily be seen in a 3 phased bone scan.
– Sweat production test: Again, excessive abnormal sweating of the affected area being one of the symptoms of the condition, a test showing levels of sweat on both limbs might hint a case of CRPS.
– X-rays: Now this would only help the physician point to CRPS only if the case is already advanced, and hence shows demineralization of the bones.
– MRI: The resonance imaging might show a change in tissue of the affected area.
However, as mentioned, these medical tests alone aren’t a 100% valid in diagnosing the pathology, although they are very useful in confirming it. Physical examination of the patient and discussion of the symptoms will help professionals with the diagnostic.
In 2004, the International Association for the Study of Pain agreed on a new set of guidelines for the diagnostic of CRPS, called the Budapest Criteria.
The Budapest Criteria is divided in 4 categories, and effectuated according to signs (physical changes evaluated by the doctor) and symptoms (only felt by the patient). For a patient to be diagnosed with CRPS, he must report at least one symptom in 3 of the 4 categories, and the physician examining him/her must see at least one physical sign in 2 of the 4 categories.
- Sensory: hyperesthesia (abnormal increase in sensitivity to stimuli of the sense, will be tested with pinprick) and/or allodynia (pain provoked by previously non-painful stimuli);
- Vasomotor: changes in skin color and/or temperature;
- Sudomotor/edema: Swelling and/or abnormal sweating of the affected area;
- Motor/trophic: decreased range of motion and/or weakness, tremor, muscular spasm (dystonia) and/or changes in hair growth, nail growth and skin texture.
In conclusion, CRPS is a difficult condition to diagnose, but not impossible. The presence of a triggering event, followed by an abnormally high amount of pain and multiple symptoms and signs found in the Budapest Criteria will help patients and physicians in diagnosing the pathology. It is important to see practitioners who are aware of CRPS, and, at times, even look for a second or third opinion in order to be sure of the final diagnosis.
Once the diagnosis is made, the patient should be looking into alleviating the pain, as a start, with OTC pain medicine. With pain levels “controlled” the patient can then look into actual treatment of the pathology. To this day, the treatment of choice against CRPS is Neridronate infusions(link al sito). It was adopted by the Italian Healthcare in 2014 and recently the “Guidelines for the Treatment of CRPS” have stated that “at the moment, the only pharmaceutical recognized valid for the treatment of CRPS is Neridronate“. Of course, patients should keep in mind that this drug alone does not act as a cure and a multidisciplinary approach gives the best chance of remission. Rehabilitative therapy is an essential tool in the treatment of CRPS and should definitely be included in the patient’s treatment path.