Show AllComplex Regional Pain Syndrome (CRPS) can happen in people of all ages, races, ethnic groups and genders. The majority of people with CRPS are females (60-80%) and adults. Children may also get CRPS. Kids actually respond the best to treatment. As stated earlier people who have had a stressful event are most at risk for developing CRPS.
We don’t know what causes CRPS. Many times we never even find out what triggered the pain cycle. Unfortunately, there is no blood test or study like an x-ray or CAT scan that can tell your doctor if you have CRPS. Bone scans may show changes but are often normal and so many times are not useful.
Sometimes CRPS is misdiagnosed. Rheumatologists are experienced in diagnosing CRPS in both people who do not have a diagnosis yet or who have been misdiagnosed. Fortunately, many patients with CRPS have very similar symptoms. This lets your health care provider better decide if you have CRPS.
The International Association for the Study of Pain (IASP), which helped develop the term Complex Regional Pain Syndrome, lists the following as important in deciding if a person has CRPS:
- Known cause for person not being able to move or clear event which started pain cycle
- Severe pain with light touch of skin, pain response which does not fit, or continuous pain
- Changes in area affected such as swelling or changes in blood flow or skin color of affected area
- No other clear cause for pain and immobility (inability to move)
- No obvious nerve damage
CRPS causes a person to experience severe pain out of proportion to things like gentle or light tough. The severe pain can occur even without stimulation or touch. Some people may have changes in their skin such as a pale, blue, red or a shiny appearance. A person may also notice swelling or stiffness in the area that is in pain. Some people feel a burning sensation, dryness, or coolness of the body part involved. In CRPS, the nerves have changed and will continue to send signals to the brain that pain is happening, even when the cycle has stopped.
The severe pain may cause a person to stop using their arm, leg or body part that is affected. If this lack of use (immobility) continues for a long time, then the bones of that body part may lose calcium. On x-rays osteoporosis may be seen. The muscles of that area also begin to atrophy (decrease in size) like someone who had their arm in a cast for several weeks.
CRPS can cause many problems, especially if it is left untreated. Treatment is focused on the different areas CRPS affects. Early diagnosis is important for preventing a prolonged course and some of the changes to the skin and bones discussed earlier.
Aggressive management, with a team approach, is important in dealing with the different parts of a person's life that CRPS may affect. A typical CRPS treatment team includes a psychologist, rheumatologist, primary care provider, nurse, social worker, school teacher, physical therapist and occupational therapist.
The aggressive treatment aims to break the cycle of pain by dealing with the different areas that CRPS can affect. The different treatments for CRPS include education about this condition, physical and/or occupational therapy, learning coping skills, normal use of the affected body part, desensitization (stopping the pain cycle by touching the body part that hurts), or medications. Surgery is rarely needed. Unless there is a medical reason for the body part to be in a cast or splint, those devices should not be used. They may actually make CRPS worse by adding to the cycle of pain and immobility. You and your treatment team must decide together what treatments are appropriate for you.
For more information about Pain Management at Cincinnati Children's, contact 513-636-7768.
