Complex regional pain syndrome (CRPS) is one of the most challenging and debilitating conditions I treat as a chronic pain physician. There are two types (Type I and Type II) and they differ based on the absence or presence of known nerve damage.
This particular pain syndrome is a diagnosis of exclusion, meaning we arrive at this diagnosis after we have exhausted all other possibilities. It typically begins after some sort of injury when the body does not heal properly and the body’s nervous system has an abnormal response leading to this horrific cycle of pain and dysfunction.
The criteria for diagnoss typically includes the following, as defined by the Current International Association for the Study of Pain:
Continued pain with no other explanation
At least one symptoms in three of the four following categories:
Sensory: Hyperalgesia (severe pain) and/or allodynia (pain with non painful stimuli such as light touch)
Vasomotor signs such as skin color changes
Sudomotor signs such as swelling or sweating changes
Trophic signs such as decreased motion/strength or changes to hair/skin/nails
At least one sign in two or more of the above categories
One important aspect of CRPS treatment that isn’t typically described is PREVENTION. Did you know daily supplementation with 500 mg of Vitamin C after wrist fractures has been shown in randomized placebo-controlled trials (i.e. well designed research studies with hundreds of patients) to decrease the incidence of CRPS (Aim et al, 2007)?
Another review of 710 studies found moderate evidence that preoperative Vitamin C can decrease postoperative pain, development of CRPS, and morphine usage postoperatively (Chen et al., 2016)
If you are considering surgery, particularly orthopedic surgery, there are ways you can optimize your nutritional status to improve your outcome and help prevent the development of CRPS and other long-term nerve pain issues.
For those patients unfortunate enough to develop CRPS, what is the key to treatment? Early diagnosis and EARLY treatment. If you notice symptoms such as those described above after a fracture, surgery, or even a seemingly simple injury, PLEASE alert your medical doctor to the possibility of this diagnosis and see a pain specialist as soon as possible.
Interventional pain procedures, such as sympathetic blocks, can greatly impact the progress of this disease and break the cycle. Also, keep moving the affected limb. Immobility has been shown to greatly worsen the prognosis (Harden, 2006).
Harden RN, Bruehl SP. Diagnosis of CRPS: signs, symptoms and new empirically derived diagnostic criteria. Clin J Pain. 22(5): 415-9. June 2006.
Aim F, Klouche S, Frison A, Bauer T, Hardy P. Efficacy of Vitamin C in preventing complex regional pain syndrome after wrist fracture: A systematic review and meta-analysis. Ortho Traumatol Surg Res. 2017. 103(3): 465-470.
Chen S., Roffey DM, Dion CA, Arab A, Wai EK. Effect of Perioperative Vitamin C Supplementation on Posteroperative Pain and the Incidence of Chronic Regional Pain Syndrome: A Systematic Review and Meta-Analysis. Clin J Pain. 2016. 32(2): 179-85.
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