Complex regional pain syndrome (CRPS) is a little-understood chronic pain condition that typically affects the arms or legs, though it can occur elsewhere in the body, according to Mayo Clinic. CRPS is also sometimes called reflex sympathetic dystrophy syndrome and causalgia. The condition usually occurs after an injury, though its cause is unknown. CRPS symptoms are burning pain; increased skin sensitivity; changes in skin temperature, color and texture; changes in hair and nails; joint stiffness and swelling; muscle spasms and weakness; and loss of function. Treatment works best when it starts early.
Drugs
Symptoms vary widely among CRPS patients, and doctors will tailor their treatment to a particular case, according to Mayo Clinic. Some patients do well on over-the-counter anti-inflammatory painkillers like aspirin and ibuprofen. Others succeed on prescription painkillers, anti-depressants, anticonvulsants like gabapentin that can treat nerve pain or corticosteroids that reduce inflammation. Some doctors have had success with bone-loss medications like alendronate. Topical analgesics can sometimes reduce skin sensitivity. However, no medications have provided consistent, long-lasting relief from symptoms, according to the National Institute of Neurological Disorders and Stroke.
Physical Therapies
A number of therapies can be used to treat CRPS, depending on a patient's needs and response, according to Mayo Clinic. Physical therapy can help improve the range of motion of a limb that is affected by CRPS. Transcutaneous electrical nerve stimulation or TENS works by applying electrical impulses to nerve endings. Biofeedback works by making patients more aware of the body so that they can relax to help reduce pain. Spinal cord stimulation works by inserting small electrodes directly into the spine to deliver a small electrical current that can reduce pain for some patients.
Counseling
Psychological counseling can help CRPS patients cope with the difficult emotions caused both by being in constant pain and not being believed by family and friends, according to Mayo Clinic. Patients with CRPS often suffer from depression, anxiety or post-traumatic stress disorder, which complicates treatment and may increase the perception of pain, according to the National Institute of Neurological Disorders and Stroke. Counselors can help patients with relaxation techniques and coping skills that can reduce suffering.
Nerve Blocks
Some patients respond well to nerve blocks, according to the National Institute of Neurological Disorders and Stroke. Doctors inject an anesthetic next to the spine to numb the sympathetic nerves to the affected body part, which reduces pain at least temporarily. This can make physical therapy easier to tolerate as well as improve mood and activity levels, according to the American Society for Surgery of the Hand. An intravenous infusion of phentolamine can also be used to block the sympathetic nerves.
Surgery
In patients that respond well to nerve blocks, a surgical nerve block, called a sympathectomy, can provide a more permanent, though controversial solution, according to the National Institute of Neurological Disorders and Stroke. The surgeon destroys the nerves causing symptoms in the affected limb. Some experts think this actually can make CRPS worse but others have reported successes with it, according to the National Institute of Neurological Disorders and Stroke. When a compressed nerve triggers CRPS, sometimes surgery is used to release pressure on the nerve. Also, sometimes a drug pump is surgically implanted to deliver pain medications into the space around the spinal cord.
