Complex Regional Pain Syndrome (CRPS)
COMPLEX REGIONAL PAIN SYNDROME (CRPS)
Complex Regional Pain Syndrome (CRPS) is a chronic pain condition that usually affects a limb after an injury, surgery, fracture or other tissue trauma. The pain is often more severe and persistent than would normally be expected from the original injury and may be accompanied by changes in sensation, skin temperature or colour, sweating, swelling and movement.
CRPS can significantly affect mobility and function. Early recognition and appropriate treatment may help prevent persistent disability and improve recovery.
Types of CRPS
CRPS, Type - I (Reflex Sympathetic Dystrophy) - Without confirmed evidence of a specific nerve injury.
CRPS, Type - II (Causalgia) - When there is evidence of a specific peripheral nerve injury.
Both types can produce similar pain and autonomic, sensory and motor changes.
Diagnosis,
There is No single test that confirms CRPS.
Diagnosis is primarily clinical and is based on the patient's history, symptoms and physical examination.
The Budapest diagnostic criteria are commonly used to assess the characteristic sensory, vasomotor, sudomotor/oedema and motor/trophic features of CRPS.
Investigations such as X-rays, MRI, nerve conduction studies or other tests may be used selectively to support the diagnosis or rule out other conditions, depending on the clinical presentation.
Treatment,
Treatment is individualized and is generally most effective when started early. The goals are to reduce pain, restore movement and function, prevent complications and improve quality of life.
1. Physiotherapy & Rehabilitation -
Gradual movement, desensitization, stretching, strengthening and functional rehabilitation are important components of treatment. Therapy aims to restore normal use of the affected limb while avoiding prolonged immobilization.
2. Heat or Cold Therapy -
help reduce pain, swelling and discomfort in selected patients with CRPS.
3. Transcutaneous electrical nerve stimulation (TENS) -
Mild electrical impulses to the nerve endings, blocking pain signals from reaching your brain.
4. Medications -
Depending on the symptoms and stage of the condition, medications may include Analgesics, Antidepressants and anticonvulsants.
5. Psychological Support -
Chronic pain can affect sleep, mood and daily functioning. Psychological and behavioural strategies can help patients develop effective pain-coping skills.
6. Sympathetic Blocks -
In selected patients, image-guided sympathetic nerve blocks may be used to reduce sympathetic-mediated pain and facilitate participation in rehabilitation.
7. Targeted Nerve Blocks, Peripheral Nerve Procedures or Other Image-Guided Interventions -
Depending on the affected region and clinical features in selected patients.
8. IV Ketamine Therapy -
In selected patients with severe, persistent CRPS that remains inadequately controlled with conventional treatment. Ketamine acts on NMDA receptors involved in abnormal pain processing.
9. Radiofrequency Procedures -
Selected patients with persistent sympathetically mediated pain may benefit from targeted radiofrequency procedures.
10. Spinal Cord Stimulation (SCS) -
For selected patients with severe, persistent CRPS that remains inadequately controlled despite comprehensive conservative and interventional treatment, spinal cord stimulation may be considered.
At AREVA
At AREVA, we focus on early recognition of CRPS and a personalized, multidisciplinary approach combining pain management, rehabilitation and selected minimally invasive, image-guided interventions. The aim is to control pain, restore movement and function, and help patients return to their daily activities.