Stages of Complex Regional Pain Syndrome

Complex regional pain syndrome is a chronic pain condition that usually occurs after a trauma or injury. This broad term describes prolonged pain and inflammation, resulting in either acute short-term or chronic long-lasting pain. The main symptoms include swelling, severe pain, changes in the skin, and loss of range of motion. Although CRPS can occur anywhere on the body, it typically affects the legs, feet, arms, and hands. It’s also one of the most misdiagnosed and misunderstood chronic pain conditions, so it’s important to arm yourself with as much knowledge as possible when it comes to this syndrome.

What Is Complex Regional Pain Syndrome?

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Although doctors don’t know the exact cause of CRPS, it typically occurs due to major trauma such as an amputation or fracture. Nerves become injured or displaced due to splintered bones or from a constricting cast. However, CRPS can also be triggered via other factors, some of which include the following:

• Heart attack.
• Infection.
• Nerve injury.
• Strain or sprain.
• Stroke.
• Surgery.

If you have CRPS, you likely have one of two different types: type 1, which was previously known as reflex sympathetic dystrophy, and type 2, which was known as causalgia. The difference between these two types involves whether or not nerve damage is involved. With type 1, no nerve damage occurs, while type 2 involves nerve damage. According to the National Institute of Neurological Disorders and Stroke, approximately 90% of people who have CRPS have type 1. Also, CRPS is more common in women, but it can occur in just about anyone, with those around the age of 40 experiencing it most often.

The amount of severe pain you experience is directly proportionate to the initial medical condition or injury. As a result, CRPS follows three stages of development.

Complex Regional Pain Syndrome Stage One

Stage one, also known as the acute stage, typically lasts one to three months, and it can involve a variety of symptoms that affect the limb. You might experience severe burning or pain as if your affected appendage encounters pressure. Pain might spread to most of the arm or leg, even if the originally affected area was smaller. In rare instances, the pain might occur in a similar location on the opposite arm or leg, acting almost like a mirror effect.

You might also find that your skin temperature changes drastically. For instance, you might have cold and clammy skin or be extremely sweaty. The skin on the affected limb might change color, becoming blue, gray, red, or purple. These skin symptoms fluctuate since they signal a change in blood flow to the area.

One main symptom you might experience in this stage involves impaired muscle movement and strength, even though you don’t have a direct injury to the nerves that deal with coordinating muscle movement. The reduction in movement is usually due to pain and poor circulation.

Complex Regional Pain Syndrome Stage Two

The second stage, also known as the subacute stage, usually lasts three to nine months and involves progressing symptoms. During this time, your skin might continue to change and nails become brittle and easily cracked. The intensity of the pain increases substantially in the joints, causing them to stiffen and swell and the muscles to weaken. You will also likely experience severe and constant burning pain and difficulty in motility where you experience pain. Hair growth also tends to slow down during this stage.

Complex Regional Pain Syndrome Stage Three

If you enter his phase, which is also known as the chronic stage, you’re probably experiencing constant pain since this stage occurs about a year after the initial onset. This stage can also last for several years or the rest of your life. The pain intensity might be intermittent or remain constant, but you’re usually limited in performing simple daily tasks. In certain situations, atrophy can develop and lead to the loss of function involving the limb. Extreme cases might involve frozen shoulders or claw hands.

Diagnosis of Complex Regional Pain Syndrome

Since the cause of CRPS isn’t completely understood, it’s best to meet with a doctor if you’re experiencing severe pain that affects your limbs. Your doctor will likely have you undergo a complete workup to exclude other disorders or diseases since there are no specific tests designed to detect CRPS. To diagnose CRPS, doctors usually eliminate potential causes and eventually can pinpoint that CRPS is the culprit. In addition to the blood tests, you might have bone scans, MRIs, and X-rays to examine any tissue changes. While the results won’t confirm CRPS, they will help guide specific treatment options.

Treatment Options for Complex Regional Pain Syndrome

Unfortunately, CRPS has no cure. Because there is no cure, treatment of CRPS typically refers to symptom management and pain management. Treatment is often most effective when begun early to alleviate any symptoms and slow down the progression. Some of the more common ways to deal with CRPS include the following:

• Medication: Your doctor might prescribe several different types of medications to help you deal with symptoms. You might take blood pressure medications, steroids to help with inflammation, antidepressants, and pain medications.
• Occupational or physical therapy: Perhaps the most important treatment option for CRPS, physical therapy is vital to keep the limbs moving to improve blood circulation, maintain flexibility, and prevent muscle tissue loss.
• Psychotherapy: If you’re feeling depressed, anxious, or experiencing post-traumatic stress disorder, you might want to seek psychological treatment.
• Spinal cord stimulation: Consider having stimulating electrodes placed through a needle into the spine via the spinal cord. This helps to blocks pain sensations and normalizes the communication between the brain and spinal cord.
• Surgery: Considered a last resort, surgery involves cutting the nerves and preventing painful impulses from reaching the brain.

Contact Dr. Knight at The Hand and Wrist Institute Today!

Don’t wait another day to get relief from pain caused by CRPS. If you’re dealing with this painful condition, contact The Hand and Wrist Institute and Dr. John Knight at either the Dallas or Southlake office. Dr. Knight and his pain management colleagues work hard to make sure you are relieved of your pain, whether that involves surgical or non-surgical treatment options.

Dr. John Knight

Dr. Knight is a renowned hand, wrist and upper extremity surgeon with over 25 years of experience. Dr. Knight is a Board Certified Orthopedic Surgeon and Fellowship trained. Dr Knight has appeared on CNN, The Doctors TV, Good Morning America, The Wall Street Journal, The Washington Post, Forbes, The Huffington Post, Entrepreneur, Oxygen network and more.