Advanced Pain Therapy, LLC
(973) 917-3172
RSD/CRPS (Complex Regional Pain Syndrome)
This is a chronic neurologic syndrome caused by overactivity of the sympathetic nervous system. It usually results from trauma but can also have an unknown cause. Typically an arm or leg is involved and it is caused by traumatic inflammation due to injury or maybe caused by over-activity of the immune system. This syndrome is painful, complicated, and frustrating.
Symptoms include:
- Severe burning pain plus extreme sensitivity that is more intense than expected for that particular injury.
- Pain which gets worse over time with significant sweating, swelling, bone and/or skin changes, insomnia, and emotional
problems.
CRPS type 1: Minor injury such as fall, sprain, fracture, burn, or tendon injury.
CRPS type 2: Causalgia has definitive identifiable major nerve injury. With both types, there is an injury which ends in a cycle of pain due to sympathetic nerve overactivity and does not follow normal pathway of healing.
Diagnosis: Patients have hyperalgesia and allodynia plus pain even to light touch usually with swelling. It is possible to have extreme pain even without touch. There are often temperature changes of the skin (over 1-degree Celsius) in comparison to the opposite limb. Tests used in diagnosis may include nerve conduction studies, thermography, bone scans, and x-rays. The most significant overriding feature is “out of proportion” pain than what would be expected for that particular injury.
Treatment outcome of CRPS is significantly better when the diagnosis and treatment are started early on.
Treatments include:
- Sympathetic nerve blocks or stellate ganglion nerve blocks which reduce the pain, increase the function, and “break the cycle of CRPS.”
- Physical therapy involving “range of motion exercise, exercises, increasing joint activity.”
- Medications: narcotic pain medications, antidepressants, steroids, anti-inflammatories, and blood pressure medications.
- Spinal cord stimulator. Electrodes around spinal cord send electrical impulses which distract the brain from the pain.
- Intrathecal drug pump infuses/pumps medication around spinal cord providing pain relief.
- Cognitive behavioral therapy which assists in adapting to chronic pain.Most recent studies show success rate of 80% when treatment is started within the first two years, 70% success rate two to five years, and drop to a 10%-20% after five years.