What is Complex Regional Pain Syndrome?
Complex regional pain syndrome (CRPS) is a chronic pain condition that most often affects one limb usually after a trauma. CRPS is characterized by prolonged or excessive pain and changes in skin color, temperature, and/or swelling in the affected area. CRPS is believed to be caused by malfunction of the nervous system. CRPS represents an abnormal response in the nervous system that amplifies the effects of an injury. As pelvic pain and health specialists, we treat many patients that have CRPS affecting the pelvic region. Whether from trauma or prolonged injury, we can help alleviate chronic pelvic pain.
What Are The Symptoms of Complex Regional Pain Syndrome?
- Prolonged Severe Pain
- May be described as burning or a “pins and needles” feeling
- Spreads throughout entire limb
- Allodynia, where normal contact with the skin such as soft cotton is experienced as extremely painful
- Changes in skin color, temperature, or swelling
- Changes in hair growth or nail growth patterns
- Abnormal sweating
- Stiffness in joints
- Abnormal movements in the affected limb
Reflex Sympathetic Dystrophy Syndrome Risk Factors
We do not know why some people develop CRPS after trauma or injury and other’s do not. A prolonged injury or delayed treatment is the same way, some people develop CRPS while other’s do not.
What Are Some Options For Treatment of CRPS?
Physical Therapy: A physical therapy program to promote range of motion and movement of the affected body part can improve blood flow. Additionally, exercise can help improve the affected limb’s flexibility, strength, and function. Rehabilitating the affected limb also can help to prevent or reverse the secondary brain changes that are associated with chronic pain. Pelvic floor physical therapy is a key piece in the comprehensive treatment protocol we require of our patients.
Occupational Therapy: Occupational therapy can help the individual learn new ways to work and perform daily tasks.
Psychotherapy: People with CRPS may develop depression, anxiety, or post-traumatic stress disorder, all of which heighten the perception of pain and make rehabilitation efforts more difficult. Treating these secondary conditions is important for helping people cope and recover from CRPS.
Medications: Several different classes of medication have been reported to be effective for CRPS, particularly when used early in the course of the disease. However, no drug is approved by the U.S. Food and Drug Administration specifically for CRPS, and no single drug or combination of drugs is guaranteed to be effective in every person. Drugs used to treat CRPS include:
- Bisphosphonates
- Corticosteroids (in early stages)
- medications used to treat neuropathic pain, such as gabapentin, pregabalin, amitriptyline, nortriptyline, and duloxetine
- topical local anesthetic creams and patches such as lidocaine.
All drugs or combination of drugs can have various side effects such as drowsiness, dizziness, increased heartbeat, and impaired memory. Inform a healthcare professional of any changes once drug therapy begins.
Sympathetic nerve block: Some individuals report temporary pain relief from sympathetic nerve blocks, but there is no published evidence of long-term benefit. Sympathetic blocks involve injecting an anesthetic next to the spine to directly block the activity of sympathetic nerves and improve blood flow.
Additional Treatments Options:
- Behavior Modification
- Acupuncture
- Relaxation techniques (such as biofeedback, progressive muscle relaxation, and guided motion therapy)
Emerging Treatments for CRPS Include:
Intravenous immunoglobulin (IVIG): Researchers in Great Britain report low-dose IVIG reduced pain intensity in a small trial of 13 patients with CRPS for 6 to 30 months who did not respond well to other treatments. Those who received IVIG had a greater decrease in pain scores than those receiving saline during the following 14 days after infusion.
Graded Motor imagery: Several studies have demonstrated the benefits of graded motor imagery therapy for CRPS pain. Individuals do mental exercises including identifying left and right painful body parts while looking into a mirror and visualizing moving those painful body parts without actually moving them.
If you are suffering from any pelvic health or pain concerns please contact Pelvic Rehabilitation Medicine today to get you on the path to finding relief.
Relevant Publications/Citations
Norman J. Marcus, MD Allyson Augusta Shrikhande, MD Bill McCarberg, MD Edward Gracely, PhD. A Preliminary Study to Determine if a Muscle Pain Protocol Can Produce Long-Term Relief in Chronic Back Pain Patients. Pain Medicine. 2013 Aug; 14(8): 1212–1221. Link to Article.
Allyson Augusta Shrikhande, MD, Robert A. Schulman, Brian S. Lerner, Alex Moroz. Acupuncture for Treatment of Chronic Low-Back Pain Caused by Lumbar Spinal Stenosis: A Case Series. Medical Acupuncture. 2011 Sep; 23(3). Link to Article.
Shrikhande A, Ahmed T, Shrikhande G, Hill C. A Novel, Non-Opiod Based Treatment Approach to Men with Urologic Chronic Pelvic Pain Syndrome (UCPPS) Using Ultrasound Guided Nerve Hydrodissection and Pelvic Floor Musculature Trigger Point Injections. The International Continence Society. 2018 Aug. Link to Article.