Complex Regional Pain Syndrome (CRPS) Treatments : How Is Pain Managed?

By January 26, 2021 April 20th, 2021 Blog, Chronic Regional Pain Syndrome (CRPS)
Man holding his wrist in pain suffering from complex regional pain syndrome.

What is it? And how do you manage the unpredictable CRPS pain?

Complex Regional Pain Syndrome (CRPS) is a rare, debilitating disorder that usually follows an injury.1 After a physical injury, stroke, heart attack, or surgery, the nerve to the respective area works overtime. This makes your brain get injury signals long after the real injury is resolved. It’s a nerve and inflammation response that’s disproportional to the injury.

While it can happen to anyone, it’s most common in women around the age of 40.2 The most common cause is a broken bone, particularly in the wrist.3 And in less than 10% of cases, there’s no injury or apparent cause at all.

What are signs of complex regional pain syndrome?

It’s not well understood. Understandably, this makes CRPS an extremely frustrating and exhausting condition. The common problems that accompany it include:

  • Inflammation. The area may look like it was recently injured or infected even though the initial injury was long ago.
  • Edema. CRPS can cause a swelling without the redness of inflammatory swelling.5 The leg of someone with CRPS can look like the leg of someone who has swollen legs from standing for a long time. However, the swelling with CRPS is constant.
  • Abnormal sweating. In CRPS, it’s not just the pain-perceiving nerves that suffer. The nerves that control your automatic processes also become dysregulated.
  • Skin, muscle, tissue, and bone wasting. These are called trophic skin changes. This comes from the interrupted nerve supply.
  • Abnormal hair and nail thinning and thickening. Similar to the previous symptom, hair and nails can waste away or build up.
  • Asymmetrical/distorted shape of extremities. CRPS frequently affects hands or feet, especially on one side. The extremity suffers stiffness in the joints which causes a characteristic flexed position.
  • Pain and sensitivity. The most prominent symptom is persistent pain. The pain can be burning, tingling, or sharp. It can also make the skin sensitive—CRPS pain can show up as sensitivity to a stimulus that shouldn’t be painful. For example, touching lukewarm water may overwhelm pain receptors.

Fibromyalgia is a common self misdiagnosis. Both CRPS and fibromyalgia have similar pain that negatively impacts energy and functioning. But CPRS will present more physical problems. Fibromyalgia is generally more widespread, less intense, and shows up with tenderness. CRPS has characteristic skin color and temperature changes.6 Fibromyalgia is more invisible, but CRPS has physical symptoms, as discussed above.

What are some complex regional pain syndrome treatment options?

Unfortunately, treatment is complex and outcomes are unpredictable. It will also depend on whether your CRPS is type l or ll. Type I isn’t from a specific nerve injury, while type ll is. CRPS shows up differently from person to person. For some people, the pain resolves itself over time. For other people, the pain goes in and out of remission. Currently, there’s no cure for CRPS, but there are management options.7

Medications
The cause of the pain in CRPS isn’t always clear. But intense inflammation, nerve pinching, and inappropriate nerve firing are frequent offenders. If your doctor estimates or concludes one of these may be the problem, you may be prescribed medication targeting the specific issue. Anti-inflammatory medications, pain medications, anticonvulsants, and steroids have been used to treat CRPS. Antidepressants and anti-anxiety medications have also been used to help manage the stress of chronic pain.

Physical therapy
Physical therapy can help if you have had CRPS for less than a year. It can improve stiff joints, edema, mobility, and pain tolerance. PT for CRPS can include aquatic therapy, gradual weight-bearing, stretches, fine motor control, and desensitization.8

Hot and cold therapy
Applying heat packs or ice packs can help alleviate the discomfort.

Nerve blocks
Studies have shown that some patients with CRPS have profound relief with nerve blocks. It’s relatively new management for CRPS. This can be an excellent option if the pain keeps you from tolerating physical therapy or daily activities. A numbing agent is injected at a nerve site and lasts a few weeks.9

CBT therapy
CRPS pain is only increased with its negative mental health effects. Cognitive-behavioral therapy can help you deal with the stress of pain, treatments, and CRPS symptoms.

Surgery
Surgery can offer some of the longest-lasting pain and symptom relief from CRPS. The nerve can be blocked. In one study on the surgical outcomes for CRPS, 80% of for both upper or lower extremities had good to excellent outcomes.10 If your other treatments have failed, consider talking to your doctor about getting a referral to a skilled nerve surgeon.

Several new treatments for CRPS are developing.

  • Intravenous ketamine. While it’s certainly not the first line of defense, IV ketamine has been used to tremendously dampen the overactive nerves in CRPS. However, there’s lots of room for more studies in this area.
  • Spinal cord stimulation. This pain management system sends an electrical field to block pain symptoms to your brain. It’s been successfully used on some patients who have failed back surgery or peripheral neuropathy.12
  • Biofeedback. With this treatment, sensors are placed on your body to give your therapist data about your pain. From there, you can develop intense awareness and focused relaxation techniques to reduce the pain.
  • Botox injections. This injection temporarily paralyzes the nerves, keeping them from overacting.
  • Transcutaneous electrical nerve stimulation. Low voltage electrical currents block or change the pain stimulus at the nerve site. The relief isn’t long-term, but it dramatically helps you tolerate activity.13
  • Local anesthetic patches or creams. Anesthetics like lidocaine have been used as an easily-applied, low maintenance pain management.

Ready for relief from your chronic pain?

Surgical intervention for chronic pain is our specialty. You may feel like you’ve tried almost everything to relieve your nerve pain. You’re not alone. Dr. Tollestrup has helped relieve the chronic pain of many people in your situation. His team would love to talk to you about getting your functionality and comfort back. Read about some of our success stories of people like you that, with Dr. Tollestrup’s help, finally got their chronic pain under control. You or your doctor can contact our team today at (702) 505-8968.

References:

  1. https://rsds.org/telltale-signs-and-symptoms-of-crpsrsd/
  2. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Complex-Regional-Pain-Syndrome-Fact-Sheet
  3. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Complex-Regional-Pain-Syndrome-Fact-Sheet#:~:text=In%20more%20than%2090%20percent,sensory%20and%20autonomic%20nerve%20fibers.
  4. https://pubmed.ncbi.nlm.nih.gov/19300041/
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6407989/#:~:text=Relative%20to%20CRPS%2C%20FM%20is,injury
    %2C%20suggesting%20local%20sympathetic%20hyperactivity
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6407989/#:~:text=Relative%20to%20CRPS%2C%20FM%20is,injury
    %2C%20suggesting%20local%20sympathetic%20hyperactivity
  7. https://www.mayoclinic.org/diseases-conditions/crps-complex-regional-pain-syndrome/diagnosis-treatment/drc-20371156
  8. https://www.physio-pedia.com/Complex_Regional_Pain_Syndrome_(CRPS)
  9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5959427/
  10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2649919/
  11. https://arizonapain.com/new-treatments-for-crps/
  12. https://pubmed.ncbi.nlm.nih.gov/19964771/
  13. https://pubmed.ncbi.nlm.nih.gov/26922847/
[If you suffer from chronic pain or suspect that you have CRPS, see a doctor about your health concerns. This article is not medical advice and should not be used to diagnose or create treatment plans.]