Complex Regional Pain Syndrome (CRPS) is a chronic pain condition that
typically affects one limb, usually after an injury. However, it can spread to
other parts of the body.
It is characterised by prolonged or excessive pain and changes in skin colour,
temperature, and swelling in the affected area.
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What is CRPS?
CRPS is a multifaceted condition involving the nervous system, which causes significant discomfort and functional impairment. There are two types of CRPS:
- CRPS-I (formerly known as Reflex Sympathetic Dystrophy): Occurs without a confirmed nerve injury.
- CRPS-II (formerly known as Causalgia): Associated with a distinct nerve injury.
For many people with the condition, symptoms are pain that’s much more severe and lasts longer than normal.
Symptoms of CRPS
The symptoms of CRPS can vary greatly in intensity and duration from person to person. This condition may gradually improve over time, but some individuals may experience persistent pain for many years.
Common symptoms of CRPS include:
- Persistent burning or throbbing pain: Typically in the arm, leg, hand, or foot.
- Sensitivity to touch or cold: Even a light touch or a slight temperature change can cause intense pain.
- Swelling and stiffness in affected joints: These can limit movement and function.
- Changes in skin temperature and colour: The skin may become sweaty and change from white and mottled to red or blue.
- Changes in skin texture: The affected area may become tender, thin, or excessively shiny.
- Abnormal hair and nail growth: There may be rapid hair growth or unusual patterns of hair and nail growth.
- Muscle spasms, tremors, and weakness: These can affect the affected limb's functionality and mobility.
Chronic Pain
As mentioned previously, CRPS pain is often triggered by an injury, but the pain is more severe and long-lasting. Often, individuals living with CRPS have periods of pain which are referred to as flare-ups. These can last anywhere between a few days or weeks.
Being stressed is known to be a leading factor of flare-ups which is why relaxation techniques and mindfulness training can be an integral part of treating CRPS.
There are medical terms used to describe these symptoms, which are:
- hyperalgesia - experiencing heightened pain than usual to something painful.
- allodynia - experiencing pain from something that does not usually cause pain, for example, a light touch or pressure applied to the skin.
Additional Symptoms
As well as chronic pain, CRPS can also result in other symptoms which
include:
- Feelings of sensation in the affected limb - this may include a sense of detachment from the rest of the body, or a perception of the limb being larger or smaller than the unaffected limb on the opposite side.
- Differing changes in the skin - you may experience periods where your skin is red, hot and dry and other times it may be blue, cold and sweaty. Note: skin changes may be harder to see on black or brown skin.
- Changes in hair and nails - in the affected limb, your hair and nails could grow unusually slowly or quickly, and nails may also become brittle or grooved.
- Stiffness and swelling in joints - this may occur where the affected limb is (oedema)
- Trouble sleeping - (insomnia)
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Physical Complications of CRPS
In some rare circumstances, CRPS can lead to physical complications. These are:
- Bed sores, also known as pressure ulcers.
- Muscle atrophy, where the muscles begin to deteriorate.
- Muscle contractures, this is when muscles shorten and lose the normal range of movement.
All of the above can make it difficult to move and get around for someone with CRPS.
What Causes CRPS?
The exact cause of CRPS is not fully understood, but it is believed to result from dysfunction in the central or peripheral nervous system. Potential triggers include:
- Trauma or injury: Such as fractures, sprains, or surgery. Even minor injuries can sometimes lead to CRPS.
- Nerve damage: Particularly in CRPS-II, where there is a direct nerve injury.
- Immune system response: Inflammatory responses following an injury might contribute to CRPS development.
- Genetic factors: There may be a genetic predisposition that increases the risk of developing CRPS.
Mental Health and CRPS
CRPS not only affects physical health but can also have profound impacts on mental well-being. The chronic nature of the condition, along with persistent pain and physical limitations, can lead to various psychological challenges.
Here’s how the condition can lead to mental health problems:
Chronic Anxiety and Stress
Persistent pain and uncertainty about the condition can lead to heightened anxiety and stress levels. Patients often worry about the progression of CRPS and its impact on their daily lives and future.
Depression
The ongoing pain and physical restrictions can lead to feelings of hopelessness and sadness. Depression is common due to the chronic nature of CRPS and its impact on quality of life.
Sleep Disturbances
Pain and discomfort can lead to difficulty falling asleep or staying asleep, resulting in insomnia. Poor sleep quality further aggravates mental health issues, creating a vicious cycle of pain and psychological distress.
Social Withdrawal and Loneliness
The limitations imposed by CRPS can reduce participation in social activities and work, leading to feelings of isolation and loneliness.
Cognitive Impairments
Chronic pain and associated stress can affect cognitive functions, including concentration, memory, and decision-making abilities. These impairments can hinder daily functioning and exacerbate feelings of frustration and helplessness.
Low Self-Esteem
Changes in physical appearance, such as swelling, skin colour changes, and muscle atrophy, can affect body image and self-esteem. People with CRPS may struggle with accepting these changes, leading to reduced confidence.
Emotional Instability and Mood Swings
The constant pain and frustration associated with CRPS can result in mood swings and emotional instability. Individuals may experience increased irritability, anger, and emotional outbursts.
Diagnosing CRPS
If you, or a loved one experience pain that is preventing you from carrying out daily activities, it is worth a visit to your GP. Although it can be difficult to diagnose, it’s best to seek help at the earliest to help reduce painful symptoms.
There is no single test that can diagnose CRPS however, it is often diagnosed by ruling out other conditions with similar symptoms. These can be done by a series of tests which are:
- Blood tests - these will rule out any underlying infection or arthritis.
- MRI (Magnetic Resonance Imagine) Scan - this is to rule out problems with your bones or tissue.
- X-Ray - this is to rule out any issues with joints or bones.
- Nerve Conduction Studies - to rule out damage to the nerves.
Your GP or a specialist may also carry out a physical examination to check for physical indications of CRPS, like swelling to changes in skin temperature and appearance. The examination will be carried out carefully to not inflict further pain on the patient.
If no other possible cause can be found and a person has clear symptoms, they are usually diagnosed with CRPS. Following diagnosis or if the conclusion is uncertain, often you are referred to a local specialist pain clinic. Treatment should be started quickly so it is essential for a referral as soon
as possible.
Managing CRPS
Although there is no known cure for people with CRPS, a combination of physical treatments, medication and psychological support can help manage symptoms.
However, others with CRPS experience continuous pain despite receiving treatment.
Treatment Plans
There are 4 main areas involved within CRPS treatment. These are:
- Education and self-management - these are steps and advice on how to help manage the condition.
- Physical rehabilitation - this is designed to help improve your function and reduce the risk of long-term physical problems. Learn more about physiotherapy exercises here.
- Pain relief - to help reduce pain
- Psychological support - advice and methods on how to cope with the emotional impact of living with the condition. Examples include cognitive behavioral therapy (CBT) and group therapy sessions.
CRPS FAQ's
Here are some frequently asked questions associated with CRPS:
How does CRPS affect a person's daily life?
The chronic pain, physical limitations, and potential mental health challenges can make it difficult to perform everyday tasks, work or engage in physical activities. Simple actions such as walking, using the affected limb, or even getting restful sleep can become challenging. Additionally, the uncertainty about the condition and its long-term effects can lead to heightened anxiety and stress, affecting the over quality of life.
Can CRPS be cured?
There is currently not cure for CRPS, but early and comprehensive treatment can significantly improve symptoms and quality of life. Many patients achieve good pain control and improved functionality with a combination of medical treatments, pain therapy, and psychological support. Ongoing management is often necessary to prevent flare-ups and maintain progress.
How can family members and caregivers support someone with CRPS?
Providing understanding, empathy, and practical assistance are ways to support someone with CRPS. It's important for them to educate themselves about CRPS to better comprehend the challenges their loved one is facing. They can assist with daily tasks, offer emotional support, and encourage the individual to adhere to their treatment plan. Additionally, promoting a positive and accommodating environment can help the person with CRPS manage their condition more effectively.
Further Advice and Support
CRPS UK - A patient-led organisation, supporting people with the condition, their families, friends and healthcare professionals.
Visit the CRPS UK website for advice, support and helpful resources.
Burning Nights - An independent organisation raising awareness, education and support for people affected by CRPS through every step of their journey.
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