Chronic pain in an arm or a leg that has developed after a stroke or heart attack may be diagnosed as complex regional pain syndrome, or CRPS. This syndrome can also manifest after a surgery or injury. Rarely, a patient may develop CRPS after receiving an immunization. HPV and hepatitis B vaccines have been associated with the development of this condition. The pain associated with the original injury or condition is usually considerably less than that of CRPS.
The cause of this condition is not yet clearly understood, and it remains an uncommon occurrence. Treatment for CRPS needs to begin early for the best outcome. If caught in its early stages and treatment begins, it may improve. Some patients have gone into remission with early interventions.
CRPS is also known as reflex sympathetic dystrophy, or RSD. It is difficult to diagnose since there are many conditions that also have severe, chronic pain as a symptom. Complicating the diagnosis even more is the fact that there are conditions that have CRPS as a symptom. An accurate diagnosis is needed to identify this disorder properly.
What is CRPS?
Affecting around 200,000 people annually in the United States, CRPS is a rare chronic neuro-inflammatory disorder. Some type of trauma sets the stage for this condition. The original stimulus of trauma starts the process. Then, the nervous system and the immune system malfunction in response to tissue damage. Nerves misfire and send pain signals to the brain. The signals continue and the pain level increases past that of the original injury or trauma.
Individuals have suffered either a musculoskeletal or nerve injury before CRPS. Some patients who have had surgery also may suffer from CRPS afterward. Diagnosing the problem can be challenging, and when discovered early in development, a better outcome is more likely.
The level of pain associated with CRPS can be debilitating. Individuals with this physical disorder experience a level of pain that is much higher than what would normally be expected from the original injury. As a result, some medical professionals may believe the pain level is exaggerated by the patient. The pain associated with CRPS is not psychological. It is a very real physical condition. It is therefore important to seek care that is understanding and patient-centered. It is common for a definitive diagnosis to take anywhere from months to a year or more.
There are signs and symptoms associated with CRPS but no set standard for diagnosing the disorder. Most often it will occur in the arms, hands, legs or feet. If your pain level is increasing over and above what you would expect with the surgery, injury or vaccination, and it continues to worsen, you may have CRPS. You may also experience the following:
- Skin sensitivity with aching, cold and deep pain
- Moderate to severe pain from something that should not cause pain, such as water from a shower or the touch of clothing
- Heightened sensitivity to painful stimulation that is continuous
- Abnormal swelling in the affected area
- Unexpected changes in skin color
- Abnormal sweating in the affected area
- Limited range of motion, weakness or other motor disorders
- Abnormal skin temperature in the affected area, either warmer or cooler than expected
Women are more likely to get CRPS, although it can affect anyone including children and teens.
Diagnosis for CRPS
Diagnosing this condition is often a matter of ruling out other disorders. Patient history, clinical examination and laboratory tests are included in making a diagnosis. Some doctors may use a triple-phase bone scan to identify changes in blood circulation. A stimulus of heat, touch or cold may be applied to a specific area to determine pain level.
Usually, early in the development of CRPS, there are only a few symptoms and they may be mild. First, there must be an initial injury. Then, your doctor will look for abnormally high levels of pain after the injury that cannot be attributed to another cause. They may also check for changes in the appearance of the skin around the affected area that are not related to some other cause.
Dr. Rolland Nemirovsky specializes in pain relief and has experience in treating various types of pain. Schedule a consultation appointment for information on how he can help you achieve relief from the pain and discomfort of CRPS.