Complex Regional Pain Syndrome

Overview

In more than 90 percent of cases, patients suffered some form of injury to the affected limb before CRPS began. The injury can range from something as minor as a needlestick, to a broken bone or more severe trauma. Physicians do not know why some people develop CRPS while others do not. In rare cases, CRPS occurs without evidence of a previous injury.

The injury may cause damage to nerves resulting in moderate to severe pain. The pain may feel like pins and needles, a burning sensation or like a squeeze to the limb. Even if the injury only occurred in a finger or toe, the entire limb may develop signs of CRPS. It may go away over time or result in chronic pain that requires pain management.

CRPS Signs and Symptoms

Signs and symptoms of CRPS only appear in the affected limb and may include:

• Sensitivity to even a light touch
• Swelling
• Abnormal movements like shaking or twitching
• Weakness or inability to move
• Joint stiffness
• Change in nail or hair growth
• Change of skin texture
• Change of skin color
• Change of skin temperature

If you experience extreme pain or swelling in a limb, always seek medical attention. While you may have CRPS, the symptoms may also point to other serious conditions. Only your physician can provide the careful diagnosis necessary.

Treatment

Complex regional pain syndrome (CRPS) is painful and frightening. Your IU Health Pain Management physicians understand the challenges you face. Your physicians focus on treating chronic pain conditions and offer advanced therapies to manage your symptoms and prevent further damage.

IU Health Pain Management physicians will work with you to develop a comprehensive treatment plan that reduces pain, sensitivity and stiffness associated with CRPS.

Physical therapy can help your affected limb to function as normally as possible. Pain medicine or nerve stimulation can help alleviate your pain. IU Health Pain Management fellowship-trained physicians will use these treatments and more to help you participate more fully in your daily life as you recover from CRPS.

IU Health Pain Management physicians provide the most advanced therapies to control pain and manage symptoms of CRPS, including:

• Pain medicines. Both narcotic and non-narcotic pain medicines may effectively reduce your pain. Medicines may also reduce swelling associated with CRPS. Use narcotic pain medicines as a last resort, with caution and exactly as prescribed by your physician. They can have strong side effects such as nausea, vomiting and drowsiness and cause dependence. Pain Management physicians will work closely with you to reduce side effects and ensure safe use of medicines.
• Physical therapy
• Nerve blocks: A nerve block temporarily blocks signals between the affected nerve and your brain. Your physician injects a long-lasting anesthetic and steroid directly into your nerve. The anesthetic keeps your nerve from sending pain signals. You will experience pain relief for a few weeks. You can receive repeat injections if the effects of the medicine wear off. However, long-term use of nerve blocks is not suggested as it may cause negative side effects such as elevated blood pressure and weight gain.
• Spinal cord stimulation: Electrical signals sent through the affected nerves can disrupt pain signals, offering long-term pain relief. To test if spinal cord stimulation works for you, your physician will place temporary electrode wires under your skin into the nerves in your spinal cord. The wires are attached to a generator that sends electrical signals. If the stimulation works, you may feel tingling in your affected limb, but little to no pain. Once it is determined that the stimulation works, you undergo surgery to place all parts of the stimulation device under your skin. The procedure is minor and can be done on an outpatient basis. Once you no longer need the stimulator, it can be removed
• Intrathecal pain pump: For severe chronic pain, a pain pump that dispenses pain medicines directly into your spine may provide long-lasting relief with fewer side effects. With a pain pump, you need less medicine for greater relief of pain. A pump containing the medicine is placed under the skin of your torso. A catheter (thin tube) runs from the pump into your spine. The pump automatically dispenses medicine at scheduled times. When it is empty, your physician refills it using a needle. The therapy is completely reversible and the pump can be removed.
• Antidepressants: Chronic pain may cause feelings of depression or anxiety. Our physicians may prescribe antidepressants to improve your quality of life and ensure that your treatments give you the pain relief you need to enjoy your daily activities.
• Psychological counseling: Psychological counseling can help you through CRPS treatment and recovery. Psychologists teach you skills to cope with pain. They also help you work through dependency on narcotic medicines and refer you to support groups for people with chronic pain. Because pain is physical, not psychological, counseling only plays a supporting role in pain relief and cannot relieve pain on its own.