Living > Health
Thursday, February 23, 2012
Reflex Sympathetic Dystrophy (RSD) or more recently called Complex Regional Pain Syndrome (CRPS) is a pain condition that can evolve after injury to tissue due to trauma, surgery or immobilization (cast) to an extremity. It is a condition that occurs with no known cause, but is thought to be due to nerve fibers that innervate the bone and soft tissue to the affected extremity.
There are two types of CRPS, Type I involving bone and soft tissue injury and Type II which involves nerve injury. CRPS involves pain that is disproportionate to the initial cause of injury and persists after normal adequate healing time. CRPS is two to three times more common in females.
Changes to the skin’s color and temperature occur due to constriction or dilation of blood vessels. Early after onset of the condition the extremity can sweat, but after progression of the condition changes to dry skin and loss of hair in the area.
Patients may demonstrate allodynia, which is pain caused from a stimulus which is not normally painful such as a feather brushed against the skin. The severe pain is described as “burning or tearing” and swelling further limits the function and range of motion of the extremity.
Patients tend to protect, guard and not utilize the extremity, which then leads to increased pain and fibrosis of the joints and eventually can cause deformity to the extremity.
CRPS may affect any of the extremities, most commonly in the upper extremities. CRPS usually only presents in one extremity and begins locally in the area of injury, then progresses to possibly affect the entire extremity.
Diagnosis of CRPS is clinical and can take a long time to establish since symptom presentation varies significantly from each individual. There are no tests that specifically diagnose CRPS, but X-rays can be used to determine whether bone demineralization exists due to disuse of the extremity.
A 3-phase bone scan can be useful in early onset of symptoms and may show diffuse increased uptake in the articular and periarticular structures of the bone in the extremity.
Sympathetic Blocks can be used to help establish a diagnosis as well as treat CRPS. Stellate ganglion blocks are used for the upper extremities and lumbar sympathetic blocks are used for the lower extremities. These are performed by injection of a local anesthetic into the nerve ganglia to block pain signals from the extremity to the brain. It also helps to warm the skin and inhibit sweating of the extremity. A series of three sympathetic blocks are performed to help establish the diagnosis.
Once a patient is diagnosed with CRPS treatment with sympathetic blocks can be continued for symptom relief. Physical and occupational therapy are utilized once pain relief is achieved to help improve range of motion, strength and function of the extremity while the symptoms are controlled. Spinal cord stimulation is another treatment option which involves a device implanted against the spinal cord which conducts electrical signals to disrupt the pain signals that are sent from the affected extremity to the brain.
Some medications can be used to help control symptoms such as opioids, tricyclic antidepressants, anticonvulsants, nonsteroidal anti-inflammatories, muscle relaxers and corticosteroids. Stress can intensify the symptoms of CRPS and patients can often become depressed since they are unable to function due to the debilitating nature in the advanced stages of the condition.
Early detection and diagnosis are key to preventing CRPS from progressing to more severe and debilitating levels. The earlier treatment is initiated, the better the prognosis and more efficient symptom relief can be obtained. CRPS can remit or remain stable for years. It can also progress to other areas of the extremity or body. Pain management specialists are trained to perform the aforementioned procedures to help achieve better symptom control and pain relief, leading to better ability to function and more active lifestyle.
Vanessa Kettleman, PA-C, ATC, LAT Comprehensive Pain Care Center, Lorain.