Complex Regional Pain Syndrome

Complex Regional Pain Syndrome (CRPS) is also known as Reflex Sympathetic Dystrophy (RSD). It is an uncommon disorder of unknown etiology of a portion of the body, usually starting in a limb, which manifests as extreme pain, swelling, limited range of motion and changes to the skin and bones. The pain is described as extreme.

It may initially affect one limb and then spread throughout the body; 35% of affected people report symptoms throughout their whole bodies.

There are two subtypes: Type I occurs after an illness or injury with no direct evidence of nerve damage in the affected limb. Type II (causalgia) has distinct evidence of a nerve injury.

It is proposed that inflammation and alteration of pain perception in the central nervous system play important roles. It has been suggested that persistent pain and the perception of non-painful stimuli as painful may be caused by inflammatory molecules (IL-1, IL2, TNF-alpha) and neuropeptides (substance P) released from peripheral nerves. This release may be caused by inappropriate crosstalk between sensory and motor fibers at the affected site.

Treatment options are limited. Tentative evidence supports the use of bisphosphonates, calcitonin and ketamine[1]. Amputation of the affected limb may be the ultimate result.

A moving story can be read here.

[1] Wand et al: Interventions for treating pain and disability in adults with complex regional pain syndrome‐ an overview of systematic reviews in Cochrane Database - 2013

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