FAQ’s on RSD & CRPS
What are RSD and CRPS?
RSD (reflex sympathetic dystrophy), also called CRPS (complex regional pain syndrome), is a chronic neurological syndrome characterized by debilitating pain caused when an injury to soft tissue heals incorrectly. There are two types of CRPS, Type I is when the specific nerve injury cannot be identified, and type II (also called Causalgia), is when a distinct nerve injury has been identified.
Who gets RSD/CRPS?
Persons that have suffered an injury to a soft tissue, like a broken bone, in which the injury fails to heal properly. This improper healing disrupts the normal nerve pathways. It doesn’t require a major injury for RSD/CRPS to occur. Another cause of RSD/CRPS is excessive resorption of calcium into the blood stream after a bone injury, or an illness or disease.
What are the symptoms of RSD/CRPS?
Symptoms of RSD/CRPS may include:
- Severe pain
- Burning sensation
- Profuse, excessive sweating
- High sensitivity to touch, even a light touch can be painful
- Changes in appearance of the skin in the affected area; it may appear shiny or thin
- Changes in nail and hair growth
- Stiffness in the joints in the affected area
- Decreased coordination, lower control of the affected body part
- Tremors and jerking of the affected limb
How is RSD/CRPS diagnosed?
There is currently no single specific diagnosis method for RSD/CRPS. Diagnosis is generally based on the individual’s medical history, injury history, and based on symptoms presented. However, due to other conditions that show similar symptoms, very careful examination is required to determine if RSD/CRPS is evident.
Since there is no specific test to diagnose RSD/CRPS, testing is often performed to rule out other conditions. The main factor in RSD/CRPS is that the symptoms occur after an injury event. Occasionally an MRI (magnetic resonance imaging) or triple-phase bone scan can identify RSD/CRPS by identifying changes in the bone metabolism.
What treatments are available to patients suffering from RSD/CRPS?
- Rehabilitation therapy is often beneficial for the patient. Exercise helps to restore and improve the blood circulation to the affected area, as well as improve the flexibility and strength of the muscles and joint in the affected area. Exercising the affected muscles can also help the patient learn alternative methods of performing tasks. Physical therapy can also be beneficial by reversing or preventing neurologic brain function associated with pain.
- Psychotherapy is also used with some level of benefit for patients that experience the symptoms due to psychological symptoms. Psychotherapy can also help patients who are experiencing depression or anxiety related to their condition as it is often difficult for someone to cope emotionally with a life altering injury. Depression, anxiety and post-traumatic stress disorder can heighten perceived pain which in turn can cause rehabilitation efforts to become more difficult.
- There are medications that a physician may prescribe to patients suffering from RSD/CRPS. These include drugs like NSAIDS (non-steroidal anti inflammatory drugs): ibuprofen, aspirin, and naproxen sodium. These medications are available over the counter (without a prescription). Corticosteroids like prednisolone and methylprednisolone can also be used to ease the symptoms of RSD/CRPS, but these drugs require a prescription.
- Anti-seizure medications like gabapentin, pregabalin, amitriptyline, nortriptyline, and duloxetine have shown to be effective as well. The opioid analgesics Vicodin, oxycontin, morphine, and fentanyl, are also effective for reducing pain symptoms. Receptor antagonists such as N-methyl-D-aspartate (NMDA), dextromethorphan and ketamine, and for deep bone pain nasal calcitonin. There are topical medications that can be used directly at the affected area, these include medications like lidocaine.
- Invasive techniques can also be used. Sympathetic nerve block injections can be performed by a pain specialist. This involves an injection of a combination of pain medication and corticosteroids into the spine to numb the affected nerve trunk. Spinal cord stimulation with electrical impulse via an implanted electrode has been shown to be effective in some recipients. Surgical sympathectomy, the surgical, controlled destruction of associated nerve trunks is a controversial method often used, but it has been debated whether this procedure is beneficial or detrimental.
New procedures such as IVIG (Intravenous immunoglobulin) are emerging to treat patients that are non-responsive to other forms of treatment. This method is common in Great Britain and has shown promise in a small study group of patients that failed to gain relief from contemporary methods. More research is needed in these new procedures before they become commonplace.