Arthritis

Free Arthritis Newsletter!
Discuss in our Forum

Guide To Complex Regional Pain Syndrome (CRPS)

Part 2 of 2 - Diagnosis / Treatment of Complex Regional Pain Syndrome (CRPS)

By Carol & Richard Eustice, About.com

Updated: May 24, 2006

About.com Health's Disease and Condition content is reviewed by the Medical Review Board

See More About:

(Continued from Page 1)

How is Complex Regional Pain Syndrome Diagnosed?

Complex regional pain syndrome (CRPS) is diagnosed primarily through observation of the signs and symptoms. But because many other conditions have similar symptoms, it can be difficult for doctors to make a firm diagnosis of complex regional pain syndrome early in the course of the disorder when symptoms are few or mild. Or, for example, a simple nerve entrapment can sometimes cause pain severe enough to resemble complex regional pain syndrome.

Diagnosis is further complicated by the fact that some people will improve gradually over time without treatment.

Since there is no specific diagnostic test for complex regional pain syndrome, the most important role for testing is to help rule out other conditions. Some clinicians apply a stimulus to the area to see if it causes pain such as:

touch
pinpricks
heat
cold

Doctors may also use triple-phase bone scans to identify changes in the bone and in blood circulation.

How is Complex Regional Pain Syndrome Treated?

Because there is no cure for complex regional pain syndrome, treatment is aimed at relieving painful symptoms so that people can resume their normal lives. The following therapies are often used:

Physical therapy: A gradually increasing physical therapy or exercise program to keep the painful limb or body part moving may help restore some range of motion and function.

Psychotherapy: Complex regional pain syndrome often has profound psychological effects on people and their families. Those with complex regional pain syndrome may suffer from depression, anxiety, or post-traumatic stress disorder, all of which heighten the perception of pain and make rehabilitation efforts more difficult.

Sympathetic nerve block: Some patients will get significant pain relief from sympathetic nerve blocks. Sympathetic blocks can be done in a variety of ways. One technique involves intravenous administration of phentolamine, a drug that blocks sympathetic receptors. Another technique involves placement of an anesthetic next to the spine to directly block the sympathetic nerves.

Medications: Many different classes of medication are used to treat complex regional pain syndrome, including:

topical analgesic drugs that act locally on painful nerves, skin, and muscles
antiseizure drugs
antidepressants
corticosteroids
opioids

However, no single drug or combination of drugs has produced consistent long-lasting improvement in symptoms.

Surgical sympathectomy: The use of surgical sympathectomy, a technique that destroys the nerves involved in complex regional pain syndrome, is controversial. Some experts think it is unwarranted and makes complex regional pain syndrome worse; others report a favorable outcome. Sympathectomy should be used only in patients whose pain is dramatically relieved (although temporarily) by selective sympathetic blocks.

Spinal cord stimulation: The placement of stimulating electrodes next to the spinal cord provides a pleasant tingling sensation in the painful area. This technique appears to help many patients with their pain.

Intrathecal drug pumps: These devices administer drugs directly to the spinal fluid, so that opioids and local anesthetic agents can be delivered to pain-signaling targets in the spinal cord at doses far lower than those required for oral administration. This technique decreases side effects and increases drug effectiveness.

What is the Prognosis of Complex Regional Pain Syndrome?

The prognosis for complex regional pain syndrome varies from person to person. Spontaneous remission from symptoms occurs in certain people. Others can have unremitting pain and crippling, irreversible changes in spite of treatment. Some doctors believe that early treatment is helpful in limiting the disorder, but this belief has not yet been supported by evidence from clinical studies. More research is needed to understand the causes of complex regional pain syndrome, how it progresses, and the role of early treatment.