What is complex regional pain syndrome, and what are the causes
Complex regional pain syndrome is an uncommon form of chronic pain that usually affects an arm or a leg. After a minor trauma or a surgery, the affected site receives high levels of nerve impulses causing disabling pain that is sometimes worse than the original injury. Although the condition is most common in women aged 20 to 35, it can occur in anyone in any age. However, complex regional pain syndrome is rare in the elderly and children under age 10.
The cause of complex regional pain syndrome isn’t clearly understood, but it may be due to a dysfunctional interaction between your central and peripheral nervous systems and inappropriate inflammatory responses. Emotional stress may also be a contributing factor.
Complex regional pain syndrome occurs in two types, with similar signs and symptoms, but different causes:
- Type 1, previously known as reflex sympathetic dystrophy syndrome, affects patients without a confirmed nerve injury. About 90% of people with complex regional pain syndrome have Type 1.
- Type 2, previously known as causalgia, results from a confirmed nerve injury.
Many cases of complex regional pain syndrome occur after a forceful trauma such as a fracture or amputation, but other traumas such as surgery, heart attacks, infections and even sprains or strains can be causes.
What are the symptoms, and how do they progress?
The key symptom of complex regional pain syndrome is prolonged severe pain that may be constant. You may feel a “burning” or “pins and needles” sensation or as if someone were squeezing the affected area. Even though the original injury might have only involved a finger or toe, the pain may spread to the entire arm or leg. In rare cases, pain can sometimes even travel to the opposite limb. There is often increased sensitivity in the affected area in which even the most casual contact with the skin such as the wind blowing can cause extreme pain.
Patients also suffer from changes in skin temperature and color as well as swelling of the affected area. This is due to abnormal microcirculation caused by damage to the nerves controlling blood flow and temperature.
You may also experience
- changes in skin texture
- abnormal sweating pattern in the affected area or surrounding areas
- changes in nail and hair growth patterns
- stiffness in affected joints
- problems coordinating muscle movement
- abnormal movement in the affected limb including tremors or jerking
- increased sensitivity to pain such that a very light touch to the skin can produce severe pain
Symptoms may change over time and vary from person to person. Most commonly, pain, swelling, redness, noticeable changes in temperature and hypersensitivity (particularly to cold and touch) occur first. Over time, the affected limb can become cold and pale and undergo skin and nail changes as well as muscle spasms and tightening. Once these changes occur, the condition is often irreversible.
In some people, signs and symptoms of complex regional pain syndrome go away on their own. In others, signs and symptoms may persist for months to years. Treatment is likely to be most effective when started early in the course of the illness.
There’s no single test that can definitively diagnose complex regional pain syndrome, but your doctor will discuss your medical history and conduct a physical examination. Procedures such as bone scans and sympathetic nervous system test may catch relevant changes in your body.
What are some home remedy solutions?
Early diagnosis and treatment are important in order to prevent complex regional pain syndrome from developing into the later stages. Home treatment is not recommended, and It is important that patients do not dismiss the pain as being “in their heads.” Complex regional pain syndrome is a physiological condition, and even though it is not fully understood, it is treatable.
Treating Complex regional pain syndrome at NWA Interventional Pain
Treatment for complex regional pain syndrome is most effective when started early. In such cases, improvement and even remission are possible. Often a combination of various therapies is necessary. After a thorough physical examination and medical history, our pain clinic will develop a tailored treatment for your needs.
If diagnosed early enough, physical therapy can be useful. An exercise program can improve blood flow and flexibility in the painful areas, and in cases of chronic pain, occupational therapy can help you learn new ways to work and perform daily tasks.
Several medications can help with pain management including topical analgesics, opioid pain medications, corticosteroids, antidepressants, and anti-seizure drugs. However, even though these medicines are effective in some patients, no single drug or combination of drugs is guaranteed to be effective in every person.
The sympathetic nervous system is involved in the body’s “fight or flight” response. It is how your body protects itself in times of stress. Complex regional pain syndrome can cause the sympathetic nervous system to become dysfunctional. A sympathetic block is an injection of an anesthetic that can blunt this dysfunctional firing and improve pain and function. You might need this injection repeated as often as weekly until symptoms improve and function increases. The frequency depends on how you respond to the injection.
Spinal cord stimulation is an evolving interventional technique that can be a long-lasting pain solution for patients with chronic nerve-related pain. After you have been deemed a successful candidate, you will undergo a trial where we transmit electricity to your painful nerves through one or two epidural leads. If the trial is successful in reducing your pain, you will receive implantation where the leads go into the same area of your epidural space but are connected to an internal battery, which is secured inside your body.
Treatment for complex regional pain syndrome is best performed at a pain treatment center by a Fellowship Trained Interventional Pain Doctor. We are part of a select class who has pursued additional training to provide you with state of the art care, and we will take a systematic approach to identify the source of the pain.
What sort of problems can occur after pain treatment?
All drugs or combination of drugs can have various side effects such as drowsiness, dizziness, increased heartbeat, and impaired memory. Talk with your doctor about any changes once drug therapy begins.
Injections do not work for everyone, so you should maintain an open dialogue with the pain control clinic about the progress of your treatment. If your symptoms become more severe, you develop a fever of over 101, or you notice redness or drainage at the injection site, you should call your pain doctor or go to the nearest ER.