Understanding the Pharmacologic Therapy for Complex Regional Pain Syndrome
Understanding the Pharmacologic Therapy for Complex Regional Pain Syndrome
Complex regional pain syndrome (CRPS), previously known as reflex sympathetic dystrophy (RSD), is a syndrome that typically affects one or more extremities but may affect any part of the body. A general definition of CRPS includes regional pain that may occur spontaneously without injury involvement or may be triggered by an extremely minor or major injury. This pain can appear out of proportion to the usual course of the known trauma or lesion, if one exists. A definitive pathophysiology is unknown, which makes early diagnosis difficult. In addition, the exact incidence of CRPS is unknown. Early diagnosis is important in preventing the spread of the condition to all extremities and preventing incapacitation. If left untreated, CRPS can result in permanent deformities and chronic pain requiring a range of long-term pharmacologic and nonpharmacologic treatments. If the condition is caught early, physical therapy is a valuable tool to mobilize the affected body part, and sympathetic nerve blocks may be used to stop the progression of disease or cure the disease. In addition to physical therapy and sympathetic nerve blocks, patients may also receive the following therapies: psychotherapy, medications including intrathecal drug pumps, surgical sympathectomy, and spinal cord stimulation.
There are two types of CRPS. Type 1 is associated with a history of injury or immobilization without known nerve injury, while type 2 results from known nerve injury. Signs of CRPS involve an abnormal function of the sympathetic nervous system such as changes in skin blood flow (color of the skin and temperature changes) or sweating, movement disorders, swelling or edema, changes in tissue growth (either atrophy or dystrophy), hyperalgesia (an exaggerated sense of pain) and/or allodynia (pain occurring as a result of a noninjurious stimulus), and bone changes. FIGURE 1 depicts a possible mechanism for development of CRPS from an injury. Examples of physical presentation are shown in FIGURE 2.
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Figure 1.
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Figure 2.
Introduction
Complex regional pain syndrome (CRPS), previously known as reflex sympathetic dystrophy (RSD), is a syndrome that typically affects one or more extremities but may affect any part of the body. A general definition of CRPS includes regional pain that may occur spontaneously without injury involvement or may be triggered by an extremely minor or major injury. This pain can appear out of proportion to the usual course of the known trauma or lesion, if one exists. A definitive pathophysiology is unknown, which makes early diagnosis difficult. In addition, the exact incidence of CRPS is unknown. Early diagnosis is important in preventing the spread of the condition to all extremities and preventing incapacitation. If left untreated, CRPS can result in permanent deformities and chronic pain requiring a range of long-term pharmacologic and nonpharmacologic treatments. If the condition is caught early, physical therapy is a valuable tool to mobilize the affected body part, and sympathetic nerve blocks may be used to stop the progression of disease or cure the disease. In addition to physical therapy and sympathetic nerve blocks, patients may also receive the following therapies: psychotherapy, medications including intrathecal drug pumps, surgical sympathectomy, and spinal cord stimulation.
There are two types of CRPS. Type 1 is associated with a history of injury or immobilization without known nerve injury, while type 2 results from known nerve injury. Signs of CRPS involve an abnormal function of the sympathetic nervous system such as changes in skin blood flow (color of the skin and temperature changes) or sweating, movement disorders, swelling or edema, changes in tissue growth (either atrophy or dystrophy), hyperalgesia (an exaggerated sense of pain) and/or allodynia (pain occurring as a result of a noninjurious stimulus), and bone changes. FIGURE 1 depicts a possible mechanism for development of CRPS from an injury. Examples of physical presentation are shown in FIGURE 2.
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Figure 1.
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Figure 2.
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