Complex Regional Pain Syndrome

Understanding a patient's pain

When someone sprains an ankle or fractures a forearm, the pain is inconvenient, annoying, and usually brief. However, these traumas can spur a complex reaction from the nervous system in some patients, resulting in excruciating pain for extended periods of time, and due to the symptoms’ non-specific nature, it can be hard to pinpoint and diagnose early. But Dr. Jonathan Kost said finding and treating Complex Regional Pain Syndrome (CRPS) as early as possible will help treatment succeed. “I cannot overstate the necessity to diagnose and treat these patients as early as possible. CRPS can be cured, especially if the diagnosis and treatment is implemented early on,” Kost said. “In cases that are not cured, the goal is to improve the pain condition in an effort to maintain optimal functionality.”

The psychological toll such pain takes on a patient must also be addressed at the same time, Kost added. Studies have found that the psychological and behavioral effects of the condition exacerbate the physical symptoms and can maintain those symptoms for extended periods. Kost said that the severity of the pain can disrupt sleeping further leading to mental distress.

When a patient is suffering from CRPS they exhibit abnormal function of their sympathetic nervous system, pain in the affected limb and joint along with difficulty moving that limb. Skin texture can be thin and shiny, its color might be blotchy or streaked and the temperature can range from sweaty to clammy. Hair and nails may grow either too fast or too slow, but none of these symptoms are guaranteed. While X-rays, EMG studies, CT scans or MRIs are normal in CRPS, they may help to identify other possible causes of pain, which can result in faster diagnosis.

Treatments for CRPS tend to work best when used in tandem. They include oral and transdermal medications, physical therapy including aquatic therapy which can be gentler on the joints, sympathetic nerve blocks to stop the sensations stemming from the malfunctioning system, and psychosocial therapy to aid the patient in dealing with her new reality. But what if we could manage the pain without medication?

“One of the most exciting new treatments for CRPS is Calmare therapy, which is a non-medication, non-invasive treatment that reprocesses the abnormal pain signal and makes it normal again,” Kost said. This path involves five to 10 treatments, which last 45 minutes a piece, where surface electrodes are placed on the skin and send signals from there. Most of the time the pain reduction lasts three to six months, but in some cases the relief can be permanent. Again, the earlier the treatments are started, the more favorable the result.

Another successful treatment is spinal cord stimulation, in which medical professionals apply an electrical current to the spinal cord and a pleasant sensation blocks the brain’s ability to sense the chronic pain. Thin wires with electrical leads are placed through a needle near the spinal column. A small incision is made and a programmable generator is placed in the upper buttock or abdomen to emit the currents to the spine. The treatment has a 60 to 70 percent success rate in reducing pain in patients by at least 50 percent. It’s been approved since 1989.

Most of the time, these treatments are tried at the same time or in rapid sequence to normalize the affected pieces of the nervous system as much as possible. In treating CRPS, it is important to determine how much the sympathetic nervous system is contributing to the excruciating pain. In this way, lumbar sympathetic blocks and stellate ganglion blocks provide therapeutic benefits but also diagnostic insight.

“The main point of care is to treat the individual as a whole,” Kost said. “This means to not only treat the pain condition, but to also address and treat the patients’ functional and psychological state.”

Pain Treatment Center