Brief Overview: According to UpToDate, ‘The consensus definition of CRPS is as follows [1]: "CRPS describes an array of painful conditions that are characterized by a continuing (spontaneous and/or evoked) regional pain that is seemingly disproportionate in time or degree to the usual course of any known trauma or other lesion. The pain is regional (not in a specific nerve territory or dermatome) and usually has a distal predominance of abnormal sensory, motor, sudomotor, vasomotor, and/or trophic findings. The syndrome shows variable progression over time.’” The pain is out of proportion to the initial trauma and may include burning, swelling, hypersensitivity, skin temperature and color changes, and movement limitations. There are two types: Type I (no confirmed nerve damage) and Type II (nerve injury present). Diagnosis relies on clinical evaluation using the Budapest criteria. Early treatment improves outcomes.
Prevalence: CRPS is rare. According to UpToDate, “The estimated incidence of CRPS has been reported at 5 to 26 per 100,000 per year in population-based studies in the United States and the Netherlands.”
Etiology: Common causes of CRPS are fractures, surgery, sprains/strains, burns/cuts, being in a cast, and nerve injury. Some cases are idiopathic.
Risk Factors:
- Female
- Age (40-50 years old)
- History of fracture or nerve injury
- Conditions like diabetes, autoimmune diseases, smoking history, prior high initial pain levels, and prolonged immobilization
Commonly Associated Conditions:
- Other chronic pain conditions, such as fibromyalgia
- Psychological problems (e.g., anxiety, depression) impacting recovery
- Functional disability and diminished quality of life
Common Medications:
- NSAIDs
- Gabapentin, pregabalin
- Tricyclic antidepressants
- Bisphosphonates
- Topical lidocaine cream or topical capsaicin cream
Common Labs, Imaging, and Tests:
- There are no definitive tests, but your healthcare provider may order:
- Bone scintigraphy
- X-rays
- Autonomic testing
- Ultrasound, MRI
Common Symptoms:
- Pain – usually described as burning, stinging, tearing
- Decreased strength in the affected limb
- Edema
- Contractures
- Decreased range of motion
- Differences in skin temperature, color, sweat, or edema in comparison to the unaffected side
- Increased hair growth, increased/decreased nail growth, skin atrophy, contraction and fibrosis of the joints and fascia
- Increased sensitivity to pain, heightened pain response to something that is not normally considered to be painful, diminished sensitivity to touch
- Tremor or muscle spasm in the affected body part
Common Treatments:
- Physical therapy
- Occupational therapy
- Psychosocial assessment, behavioral therapy
- Trigger point injections
- Sympathetic nerve block
- Spinal cord and peripheral nerve stimulation
- Epidural clonidine
Physical Findings:
- Signs matching Budapest criteria (e.g., temperature asymmetry, abnormal skin color, swelling, decreased ROM)
- Absence of other neurological explanations (e.g., nerve root compression)
Potential Complications and Contraindications:
- Chronic, disabling pain even with treatment
- Psychological impact: anxiety, depression, catastrophizing
- Risk of overtreatment/unnecessary procedures—balance and specialist referral recommended
General Health and Lifestyle Guidance:
- Smoking cessation
- Work with your healthcare providers to manage chronic conditions
- Exercise as tolerated – discuss with your healthcare provider what is recommended for you
Suggested Questions to Ask Patients:
- When did your symptoms start, and what triggered them?
- What makes the pain feel better or worse?
- Have you noticed changes in skin, temperature, or swelling in your limb?
- How is this affecting your daily activities or mood?
Suggested Talking Points:
- You may be managed by a pain management specialist
- If symptoms persist, there are specialized treatment options that can be considered
- Ask your healthcare provider if compression stockings or sleeves might be helpful for you
Sources:
- UpToDate: https://www.uptodate.com/contents/complex-regional-pain-syndrome-in-adults-pathogenesis-clinical-manifestations-and-diagnosis?search=complex%20regional%20pain%20syndrome&source=search_result&selectedTitle=1~137&usage_type=default&display_rank=1
- https://www.ninds.nih.gov/health-information/disorders/complex-regional-pain-syndrome
- https://my.clevelandclinic.org/health/diseases/12085-complex-regional-pain-syndrome-crps
This content was created with the assistance of AI. Any AI-generated content was reviewed by a Nurse Practitioner.