“CRPS patients exhibit changes which occur in somatosensory systems processing noxious, tactile and thermal information, in sympathetic systems innervating skin (blood vessels, sweat glands), and in the somatomotor system.
“This indicates that the central representations of these systems are changed and data show that CRPS is a systemic disease involving these neuronal systems. This way of looking at CRPS shifts the attention away from interpreting the syndrome conceptually in a narrow manner and to reduce it to one system or to one mechanism only, e.g., to sympathetic-afferent coupling.
“It will further our understanding why CRPS type I may develop after a trivial trauma, after a trauma being remote from the affected extremity exhibiting CRPS, and possibly after immobilisation of an extremity. It will explain why, in CRPS patients with sympathetically maintained pain, a few temporary blocks of the sympathetic innervation of the affected extremity sometimes lead to long-lasting (even permanent) pain relief and to resolution of the other changes observed in CRPS.
“This changed view will bring about a diagnostic reclassification and redefinition of CRPS and will have bearings on the therapeutic approaches. Finally it will shift the focus of research efforts.”
Another excruciating symptom is our inability to regulate temperature, the processing of tactile being unbearably painful, causing processing problems in thermal response, motor response, and vasomotor response, even leading to disturbed thermoregulatory reflexes and hypoesthesia on half or a quadrant of the body.
“The basis of extensive evidence from clinical observations and experimentation on humans, the hypothesis has been put forward that CRPS is a disease primarily of the central nervous system (CNS), involving changes in central sympathetic, somatosensory, and motor systems.
For example, Wasner et al 12 have shown that thermoregulatory reflexes are disturbed in the distal parts of the affected extremity in patients with CRPS I, which has been attributed to central changes reflected by alterations in the activity in cutaneous vasoconstrictor neurons.
Rommel et al 13,14 have demonstrated that up to 50% of patients with chronic CRPS I develop hypoesthesia on the entire half of the body or in the upper quadrant ipsilateral to the affected limb.
The anatomic distribution of these changes suggests that they might be due to changes in central processing of tactile stimuli, presumably at a thalamic or cortical level.
Additionally, in many patients, motor symptoms occur, including muscle weakness, tremor, dystonia, and a neglectlike syndrome. 15,16 These motor changes are unlikely to be related to a peripheral process but are supposed to be the result of specific alterations of the central motor system induced by the disease.1,11,17,18
To help prevent CRPS ALWAYS TAKE 1000mg/day VITAMIN C AFTER ANY SPRAIN OR STRAIN – this research shows that it can help to prevent CRPS from occurring.
Complex Regional Pain Syndrome is a multi-system disorder with clinical features of neurogenic inflammation, nociceptive sensitisation (which causes extreme sensitivity or allodynia), vasomotor dysfunction, and maladaptive neuroplasticity, generated by an aberrant response to tissue injury.
Reading 42 on the McGill Pain Scale (RSD/CRPS is referred to as Causalgia, which is Latin for “burning pain”). CRPS is a debilitating disease if not treated promptly and properly. The onset of CRPS usually follows a trauma, injury or surgery and increasing evidence suggests that psychological trauma can cause CRPS or increase the chance of its development after an injury by an estimated eight times.
See this post for ways manage and treat CRPS, while this is an open letter to those without CRPS. Without going into a full description of the disease, let us initially concentrate on the four main symptoms:
Constant chronic burning pain: also throbbing, aching stabbing, sharp, tingling, and/or crushing in the affected area or areas. Allodynia is a huge problem with RSD/CRPS (extreme pain response from innocuous stimuli); even a light breeze can cause pain, let alone the noise, lights, crowds and vibrations, all having a debilitating and life-limiting effect. In CRPS normal inputs such as touch, stroking and movement are misinterpreted as painful. This ongoing “painful” interpretation is a big part of the problem.
Inflammation: is not always present. It can take various forms, the skin may appear mottled, become easily bruised, have a shiny, dry, red, and tight look to it. An increase in sweating usually occurs as well.
Spasms in blood vessels and muscles of the extremities: this results in a feeling of coldness in the affected extremity, which feels like ice between the bones or fire burning the affected areas. Because of an inability to regulate our inner thermostats, touching something cool can be excruciating or cause freezing or burning pains. It depends on how long the CRPS has been present, and whether it is typically ‘hot’ CRPS or ‘cold’ CRPS.
This is as well as body fatigue, skin rashes, occasional low-grade fever and sore throats; swelling (edema), sores, dystonia, and tremors. The spasms can be confined to one area or be rolling in nature, moving up and down the leg, arm, or back.
Insomnia/Emotional Disturbance: CRPS affects the limbic system of the brain. This causes many problems that might not initially be linked to a disease like CRPS, among them are depression, insomnia, extreme difficulty concentrating, and short-term memory problems. Cognitive difficulties similar to fibro-fog are prevalent, simply due to the sensory overload of constant severe pain.
CRPS involves a malfunction of the nervous system that causes pain (often diffuse, intense and unrelenting) and related sensory abnormalities). Dysautonomia means dysregulation of the autonomic nervous system (ANS). The ANS controls involuntary bodily synergies between the sympathetic and parasympathetic nervous symptoms.
Necessary involuntary functions include things like heartbeat, breathing, digestion, and body temperature regulation. Studies have also linked the nervous system to the immune system, suggesting a possible correlation between ANS and autoimmune disorders.
In dysautonomia, the ANS does not respond to stimuli appropriately, either the parasympathetic or sympathetic nervous system can be hyporesponsive or hyperresponsive, often heightened by physiologic and psychologic stress. In those with mitochondrial dysautonomia, mitochondrial dysfunction is believed to cause the dysautonomia.
Since mitochondria provides a source of energy for cells, fatigue related diseases are common among mitochondrial myopathies. Nerve cells in the brain and muscles require significant energy and are depleted with mitochondrial malfunction.
Abnormal regulation of body temperature in mitochondrial disease patients is common, resulting in either a lower or higher baseline body temperature or a distinct intolerance to heat or cold. There may also be abnormal blood flow and sweating in the affected areas, problems with movement of the muscles and changes in the structure of the tissues (‘trophic’ changes).
All of the above is now also attributed to the CNS involvement in CRPS/RSD. Complex Regional Pain Syndrome involves the skin, nerves, blood vessels, and bones. The sympathetic nervous system reacts to a stimulus, for example, an injury, although it could be as little as a spider’s bite. Blood flow may be affected in reaction to a burn, cut, or severe temperature changes. To stop you from using an injured limb, the limb swells. Sometimes inexplicably an abnormal or prolonged sympathetic reflex begins in a limb as reaction to a trauma.
The sympathetic nerves become overactive and can cause extensive symptoms that in turn cause debilitating consequences. There can be many symptoms but the most common one is severe, burning pain. Some of the other symptoms due to ANS dysfunction include swelling, temperature change, skin colour change, diminished motor function, and severe sweating.
These symptoms usually happen in a limb but can occur anywhere in the body, trunkel CRPS in the face or organs are some extreme examples. Symptoms may vary with each individual who has Complex Regional Pain Syndrome or CRPS/RSD.
Reflex Sympathetic Dystrophy (RSD)
Reflex Sympathetic Dystrophy/RSD is the former name for Complex Regional Pain Syndrome (CRPS). The name of Reflex Sympathetic Dystrophy (RSD) was changed to Complex Regional Pain Syndrome (CRPS) in 1993 by the International Association for the Study of Pain.
It has been known by many names such as algodystrophy or Causalgia or RSD, but is now most commonly known as CRPS. The are 2 forms of Complex Regional Pain Syndrome. The only difference between type 1 and type 2 is type two is easier to diagnose. CRPS type one is formerly known as RSD and CRPS type two was causalgia. Complex Regional Pain Syndrome and Reflex Sympathetic Dystrophy are used synonymously today.
The main goal of treatment for CRPS is reversal of the course, amelioration of suffering, return to work if at all possible, avoiding surgical procedures such as amputation, and improvement in/some quality of life. The key to success is early diagnosis and early assertive treatment. Devastatingly, lack of proper understanding and proper diagnosis leads to improper treatment with poor outcome.
Read this post on: How to Manage and Treat Complex Regional Pain Syndrome for CRPS Awareness Month
There is a desperate need for future research in the treatment of CRPS
Delay in diagnosis is a factor in therapeutic failure. According to Poplawski, et al, treatment, and its results, are hampered by delay in diagnosis. Early diagnosis (up to 2 years) is essential for achieving the goal of successful treatment results. Simple monotherapy with only nerve block, only Gabapentin, or otherwise, is not sufficient for management of CRPS.
Treatment should be multidisciplinary and simultaneous: effective analgesia, proper antidepressants to reduce pain and insomnia; physiotherapy, nerve blocks, proper diet, when indicated channel blockers, and anticonvulsant therapy should be applied early and simultaneously. Administration of minimal treatments is apt to fail leading to lifelong disability and such severe pain that work is often seldom ever returned to.