Wednesday, March 04, 2009

Complex Regional Pain Syndrome Difficult to Diagnose, Treat

Complex Regional Pain Syndrome (CRPS) is a condition which causes people to feel an unexplained, burning-type pain in part or parts of the body. Although the condition usually develops after some kind of physical trauma, the location of the injury and the location of the pain are not necessarily the same. What’s more, once CRPS flares symptoms can worsen and the pain can spread to other areas of the body.

CRPS was first identified in Civil War veterans who still felt pain at the site of their wounds, even after they were healed. First termed “causalgia,” residual unexplained pain at the site of an old injury is now called Type II CRPS. Another form of this syndrome, Type I CRPS, was formerly called Reflex Sympathetic Dystrophy (RSD), and is caused by an indirect traumatic injury, such as surgery, car accident, etc.

However, CRPS can be triggered by minor injuries as well. The current thinking is that CRPS is the result of a disruption of the healing process—the brain alerts the body to an injury, but for some reason does not receive feedback that the injury is healed. Instead, the brain continues to amp up its warning of “something is wrong” to the body in the form of increased pain sensations.

CRPS is also associated with symptoms other than pain. It can change the appearance of the skin to white, mottled, or red; and cause swelling, chills, stiffness and tremors.

There is no cure for CRPS, but in some cases symptoms improve or even disappear over time. People with this disorder can also be made more comfortable through a combination of medication and physical therapy. Pain medications, anticonvulsants, and antihypertensive medications may be prescribed, and injections that block nerves associated with the pain can help alleviate symptoms. Antidepressants can help too, not because CRPS is a psychosomatic illness, but because people in chronic pain often suffer from depression.

However, there is no one treatment that is successful for all CRPS patients. There is also no way to test for the disorder. It is diagnosed simply by ruling out other possibilities—a process that can be frustrating to say the least. Most CRPS patients see about 5 physicians before their condition is ever diagnosed.

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