CRPS Type 1

What Is CRPS Type 1?

CRPS Type 1 is a medical term for a form of Complex Regional Pain Syndrome. Another term used for CRPS Type 1 is RSD, or Reflex Sympathetic Dystrophy and these are often used interchangeably. It is the first of two known types of the medical condition and is actually the most prevalent between them. The definition of CRPS Type 1 states that it is a clinical syndrome, difficult to understand and identified by various signs and symptoms; especially a severe pain in one of the patient’s limbs. Though pain is the most common characteristic of CRPS Type 1, it is by no means the only one. Several other symptoms have been outlined in guidelines for the diagnosis of CRPS Type 1, along with possible causes of the medical condition and treatment protocols.

CRPS Type 1 Causes

In order to understand what CRPS Type 1 is, some distinction has to be made between CRPS Type 1 vs 2. The difference between the two types of CRPS is only in the causes of each, otherwise they’re practically the same. The risk factors that may result in the development of CRPS Type 1 include injuries such as sprains and strains, or surgical procedures like amputations, and even medical emergencies such as heart attacks and strokes. Although these risk factors are common in individuals who are diagnosed with CRPS Type 1, the medical condition can still develop in the absence of the above-mentioned events. On the other hand, CRPS Type 2 is believed to be a result of significant damage to the peripheral nerves which run from the spine and brain to the extremities. Such nerve damage is absent in all CRPS Type 1 cases.

CRPS Type 1 Signs and Symptoms

CRPS Type 1 is a medical condition of variable course, which means the way it presents itself and progresses differs among patients. This often makes it difficult to diagnose and treat. The best way so far to make a CRPS Type 1 diagnosis is through the signs and symptoms. Despite its variable nature, CRPS Type 1—like many other diseases and disorders—has signs and symptoms that are common in the majority of patients. These act as a guideline in diagnosis which can be carried out with the use of the Budapest Criteria diagnostic checklist. The following signs and symptoms are the most common seen in individuals diagnosed with CRPS Type 1. They may not all occur at the same time, but if you do notice any of them, it may be best to consult your doctor as soon as possible just to be safe.

  • Pain

Quantifying pain is obviously impossible as it is an experience personal to each individual. When it comes to CRPS Type 1, the most commonly used descriptions for the pain associated with the medical condition are intense, burning, throbbing, and stinging. If you feel such a pain, it’s possible that you may have CRPS Type 1. As the dominant symptom, pain is usually experienced right away and the best indicator for whether it’s associated with CRPS Type 1 is that it’s often disproportionate to whatever injury is causing the pain.

  • Hypersensitivity

This symptom is related to pain. If you have CRPS Type 1, anything can feel painful. Whether it’s the wind blowing on the affected limb, water splashing on it, or anything else; you might feel unimaginable pain from that. In the case of injuries that occur after you get CRPS Type 1, the pain from the injury is often amplified. If bumping your arm against the wall feels like it has been crushed by a truck instead, then it’s likely you’re hypersensitive to pain which can be an indication of CRPS Type 1.

  • Inflammation

Swelling is one of the CRPS Type 1 symptoms that doesn’t affect every individual with the disorder. In those who do experience this symptom, the swelling is more prominent in the beginning. After that it can come and go during flare ups, be present every day, or last for a few minutes or a couple of hours.

  • Discolouration

Changes in skin colour of a CRPS Type 1 affected limb are often an effect of other symptoms such as swelling. Skin pigmentation can even be seen in mirror-image locations on the limb opposite to the one that’s affected. The skin colour can change to purple, blue, red, or grey.

  • Burning or freezing sensation

Due to vasomotor disturbances affecting the natural processes of vasoconstriction and vasodilation because of CRPS Type 1, the affected limb can have a burning or freezing sensation depending on the ambient conditions. Slight changes in the temperature, whether an increase or decrease, can cause the affected limb to burn up or feel freezing cold, especially if you go out without covering it up.

  • Muscle spasms

These are sudden, involuntary contractions of one or several muscles. Muscle spasms in CRPS Type 1 patients are often caused by poor blood circulation in a limb which results from abnormal vasoconstriction and vasodilation.  The muscle spasms can happen in any part of the body for any duration, so even if your hand is the affected limb, the spasms might be felt on your eye or anywhere else.

  • Amplified injuries

Any injuries occurring after the onset of CRPS Type 1 will often feel more painful than is normal for the type of injury and may even take longer to heal. Infections with the injury are also common as CRPS Type 1 is an autoimmune disease.

  • Abnormal sweating

An individual with CRPS Type 1 may notice that the affected limb gets clammy and sweats easily, even while doing mundane tasks such as putting away the dishes. Some patients may not experience this symptom.

  • Lethargy

CRPS Type 1 can leave you feeling exhausted a lot more than you normally would even after simple tasks. After a diagnosis is made and treatments begin, the CRPS Type 1 medication can also contribute to weariness.

  • Urinary problems

This problem is quite common in patients with CRPS Type 1 and may sometimes be accompanied by other gastrointestinal issues such as constipation and diarrhoea. Specifically, CRPS Type 1 patients experience urinary voiding dysfunction whereby they have urinary inconsistencies. The cause of this is thought to be because CRPS Type 1 affects systems in the Sympathetic Nervous System which is part of the Autonomic Nervous System responsible for natural regulation of bodily functions such as bowel and bladder functions.

Because CRPS Type 1 signs and symptoms can be similar to those of other medical conditions such as Fibromyalgia, Sjogren’s Syndrome, Chronic Fatigue Syndrome (CFS), Raynaud’s Disease, and Myofascial Pain Syndrome; a misdiagnosis is possible even if a patient exhibits any or all of the above. Other CRPS Type 1 symptoms such as oedema, skin temperature variations, and bone loss can be identified through medical tests like MRI scans, thermography tests, and bone scans. These same tests can help rule out the diseases mentioned above when determining whether a patient has CRPS Type 1 or not.

CRPS Type 1 Treatment

The treatment for RSD/CRPS Type 1 must be individualized, which means it must be tailored to each patient. In some fortunate cases, CRPS Type 1 will improve without treatment. However, it’s risky to wait it out, because the longer the condition goes untreated, the less chances the patient has to recover. In fact, the sooner CRPS Type 1 treatment starts, the higher the chances for remission.

The main objectives of CRPS Type 1 treatment are to relieve the patient of symptoms such as pain and hypersensitivity, and alleviate effects of the disease such as joint stiffness, reduced limb functionality, and depression. A combination of treatments is required to achieve this and this CRPS Type 1 treatment combo consists of medications and different types of therapies such as physiotherapy and psychotherapy.

CRPS Type 1 medical treatment

A suite of drugs is used especially for pain relief in CRPS Type 1 patients. Some patients may need every type of drug recommended, while others may find relief from using a lot less. The types of medications used in the treatment of CRPS Type 1 include:

  • Neridronate

There’s no known cure for CRPS Type 1, but Neridronate comes pretty close. It is a bisphosphonate that reduces bone loss and was recently discovered to offer significant relief from pain in CRPS Type 1 patients. As an added advantage, Neridronate is the only drug so far with long term benefits for CRPS Type 1 treatment. That alone makes it quite desirable for anyone suffering from this medical condition. Unfortunately, Neridronate is not easily accessible since it has only been approved for CRPS Type 1 treatment in Italy for now, plus the treatments are quite costly. In the long run, it’s all worth it because a number of patients who’ve been treated using Neridronate experienced total pain relief and even CRPS Type 1 remission. For the best results, Neridronate treatment should begin as early as possible.

  • Non-steroidal anti-inflammatory drugs

These are pain killers that can help reduce pain caused by the inciting injury that causes CRPS Type 1 or even other pains that are an effect of the disease, such as muscle pain in the affected limb. Unfortunately, these drugs may not be strong enough to directly reduce the actual CRPS Type 1 pain so other drugs may be needed in addition.

  • Corticosteroids

These treat inflammation and oedema and are often used during the first stages of CRPS Type 1 when swelling is more prominent.

 

  • Calcitonin

Calcitonin may be administered via injection or a nasal spray. It is helpful in slowing down the bone loss that occurs with the advancing of CRPS Type 1 and also for pain relief.

  • Opioids

If the patient’s pain is severe, opioids such as codeine and morphine may be the best treatment for pain relief as they are very strong, but sometimes they may not be very effective on the CRPS pain. There is a risk of addiction when it comes to taking opioids so this should be considered before they are prescribed for CRPS Type 1 treatment.

  • Anaesthetics

Anaesthetics have a desensitisation effect where the patient feels a loss of sensation or awareness—even if it’s only temporary. As a result, they get temporary relief from pain as the anaesthetic effect makes them temporarily “unaware” of it or unable to “sense” it.

CRPS Type 1 physiotherapy

Physical treatments in CRPS Type 1 patients help to improve blood flow and lessen the effects of vasomotor disturbances so that the patient can regain mobility in the painful limb. Exercises also improve flexibility and strength and prevent any further damage such as muscle wastage which occurs due to a lack of physical activity.

CRPS Type 1 psychotherapy

Chronic diseases such as CRPS Type 1 are often associated with profound psychological problems in the patient and even their friends and families. For a patient with CRPS Type 1, this is detrimental to both their mental state and physical well-being because negative emotions such as depression, stress, and anxiety aggravate their symptoms. This is what is normally referred to as CRPS flare ups where a patient feels extreme pain for a period of time as a result of emotional stress. Psychotherapy is therefore important to treat these negative emotions and help the patient find ways to mentally cope with their pain and recover from CRPS Type 1.

CRPS Type 1 alternative treatments

When medications and physiotherapy fail to offer any pain relief to an affected individual, alternative treatments can be explored. Some of these are not recommended on the basis of ethical issues and others are believed to make the condition worse instead of better. This is why they are often considered as a last resort. Nevertheless, there are some treatments that are still emerging and may prove to be very effective with time.

  • Ketamine

Ketamine is a strong anaesthetic and should therefore be used in low doses, intravenously. After several days of Ketamine treatment, the chronic pain is said to reduce substantially or even be totally eliminated.

  • Sympathetic nerve block

This treatment targets the sympathetic nervous system which consists of a series of nerves from the spine to parts of the body and helps control involuntary body functions such as blood flow and sweating. For the treatment of chronic pain, an anaesthetic is injected next to the spine to block the activity of those sympathetic nerves connected to the painful region.  

  • Surgical Sympathectomy

This involves severing the sympathetic nerve chain which essentially means destroying some of the nerves. The efficacy of this treatment with regards to CRPS Type 1 is not very well detailed and the treatment is only recommended for individuals who get significant pain relief from treatments like sympathetic nerve blocks.

  • Spinal cord stimulation

This is desensitisation of sorts because electrodes are placed into the spine to stimulate the painful area and mask the pain with tingling sensations. Though helpful, the procedure may be painful and will require minor surgery to implant all the necessary equipment for the treatment to be administered.

CRPS Type 1 Prognosis

The earlier the diagnosis and treatment, the better the outcome for the patient. Since CRPS Type 1 varies among patients, it’s difficult to know exactly how any case will turn out, so each case is evaluated individually. CRPS Type 1 may fade away on its own within a few months, but some patients are not so lucky. In those cases, early treatment before permanent damage like bone and muscle changes can help the symptoms disappear in a few months. For some patients, the treatments don’t really work and the patient remains in pain for months or even years. 

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