Type two is characterized by more intense pain. Swelling spreads, hair growth diminishes, nails become cracked, brittle, grooved, and spotty, osteoporosis becomes severe and diffuse, joints thicken, and muscles atrophy.
Type three is characterized by irreversible changes in the skin and bones, while the pain becomes unyielding and may involve the entire limb. There is marked muscle atrophy, severely limited mobility of the affected area, and flexor tendon contractions (contractions of the muscles and tendons that flex the joints). Occasionally the limb is displaced from its normal position, and marked bone softening is more dispersed.
No specific test is available for CRPS, which is diagnosed primarily through observation of the symptoms. However, thermography, sweat testing, x-rays, electrodiagnostics, and sympathetic blocks can be used to build up a picture of the disorder. Diagnosis is complicated by the fact that some patients improve without treatment. A delay in diagnosis and/or treatment for this syndrome can result in severe physical and psychological problems. Early recognition and prompt treatment provide the greatest opportunity for recovery.
Physicians use a variety of drugs to treat CRPS, including antidepressants, corticosteroids, vasodilators, gabapentin, and alpha- or beta-adrenergic-blocking compounds. Elevation of the extremity and physical therapy are also used to treat CRPS. Injection of a local anesthetic, such as lidocaine, is usually the first step in treatment. Injections are repeated as needed. TENS (transcutaneous electrical nerve stimulation), a procedure in which brief pulses of electricity are applied to nerve endings under the skin, has helped some patients in relieving chronic pain. Neurostimulation (spinal cord stimulators) may also be surgically implanted to diffuse the pain by replacing it with a tingling sensation. These devices place electrodes either in the epidural space (space above the spinal cord) or directly over nerves located outside the central nervous system. Implantable drug pumps may also be used to deliver pain medication directly to the cerebrospinal fluid which allows the use of powerful opioids to be used in a much smaller dose than when taken orally. Ketamine infusion to treat CRPS has been described (Correll et al, 2004).
Surgical, chemical, or radiofrequency sympathectomy — interruption of the affected portion of the sympathetic nervous system — can be used as a last resort in patients with impending tissue loss, edema, recurrent infection, or ischemic necrosis (Stanton-Hicks et al, 1998).
Physical therapy is also an important part of treatment, though it should be noted that many patients are incapable of participating in physical therapy due to subsequent muscular and bone problems. People struggling with CRPS often develop guarding behaviors where they avoid using or touching the affected limb. Unfortunately, inactivity can exacerbate the disease and perpetuate the pain cycle. Physical therapy works best for some patients, especially goal-directed therapy, where the patient begins from an initial point, regardless of how minimal, and then endeavors to increase activity each week. While the unpredictability of this illness often causes a frustrating pattern of progress and regress, it is essential to continue to try to increase and normalize physicial activity.
Prognosis
Good progress can be made in treating CRPS if treatment is begun early, ideally within 3 months of the first symptoms. Early treatment often results in remission. If treatment is delayed, however, the disorder can quickly spread to the entire limb and changes in bone and muscle may become irreversible. In 50 percent of CRPS cases, pain persists longer than 6 months and sometimes for years.
Similar disorders
CRPS has characteristics similar to those of other disorders, such as shoulder-hand syndrome, which sometimes occurs after a heart attack and is marked by pain and stiffness in the arm and shoulder; Sudeck syndrome, which is prevalent in older people and women and is characterized by bone changes and muscular atrophy, but is not always associated with trauma; and Steinbrocker syndrome, which includes symptoms such as gradual stiffness, discomfort, and weakness in the shoulder and hand.
The National Institute of Neurological Disorders and Stroke (NINDS), a part of the National Institutes of Health (NIH), supports and conducts research on the brain and central nervous system, including research relevant to RSDS, through grants to major medical institutions across the country. NINDS-supported scientists are working to develop effective treatments for neurological conditions and, ultimately, to find ways of preventing them.Investigators are studying new approaches to treat RSDS and intervene more aggressively after traumatic injury to lower the patient’s chances of developing the disorder. In addition, NINDS-supported scientists are studying how signals of the sympathetic nervous system cause pain in RSDS patients. Using a technique called microneurography, these investigators are able to record and measure neural activity in single nerve fibers of affected patients. By testing various hypotheses, these researchers hope to discover the unique mechanism that causes the spontaneous pain of RSDS and that discovery may lead to new ways of blocking pain.Other studies to overcome chronic pain syndromes are discussed in the pamphlet “Chronic Pain: Hope Through Research,” published by the NINDS.
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COMPLEX REGIONAL PAIN SYNDROME (CRPS)
aka REFLEX SYMPATHETIC DYSTROPHY (RSDS)
RSD is also known as Complex Regional Pain Syndrome (CRPS) type 1. CRPS type 2 is causalgia which is identical to type 1 except that it is caused by a nerve lesion. Recent evidence suggests that CRPS1 is also from nerve damage.(Please see "Evidence of Nerve Damage in CRPS1" on WHAT'S NEW? page.
Other names:
* causalgia
* algodystrophy
* postraumatic dystrophy
* Sudeck's atrophy
* shoulder-hand syndrome
RSD/CRPS has existed since the American Civil War (1861-5) where Dr. Silas Weir Mitchell documented cases of causalgia in Civil War soldiers.
RSD/CRPS is a multi-system syndrome with diverse symptoms characterized by chronic pain. Usually it affects one or more extremities but it can affect any part of the body. Due to dilation or constriction of the blood vessels, the blood supply to the limb (hand, foot, hip, shoulder) is affected. The nerves, skin, muscle and bone are also involved.
RSD is a debilitating disease which can impair the ability of the limb to function or function can be lost.
How do you get RSD/CRPS?
* a soft tissue injury due to minor trauma in 65% of cases e.g. sprain, twisted ankle etc.
* fracture
* surgery
* certain cervical spine or spinal cord disorders
* infections, stroke, heart attack, repetitive motion disorder, or cumulative trauma e.g.. carpal tunnel.
* certain medications or venipuncture in rare cases
What are the symptoms?
* PAIN usually burning, severe, constant and in an area other than the primary injury site
* SWELLING usually localized but can involve entire limb
* SKIN CHANGES: TEMPERATURE or COLOUR: E.G. dystrophy, dryness, tissue atrophy e.g.. can be cool and pallid or mottled; or warm and red with increased sweating.
* LIMITED AROM (active range of motion) in the affected part
* INCREASE OF ABOVE COMPLAINTS after exercise
What other symptoms are there?
* motor dysfunction e.g. tremor, weakness, dystonia, spasms
* dystrophy e.g. muscle wasting
* limbic system dysfunction e.g.. insomnia, agitation, anxiety, depression, poor memory or judgment
* hair and nail changes
* bone changes e.g.. osteoporosis
* joint tenderness and swelling
How is it diagnosed?
There is NO SINGLE TEST available to diagnose RSD/CRPS.
* thorough medical history noting sign and symptoms
* examination by a qualified expert physician
* thermography which measures the heat emitted from the body and senses skin temperature differences (may help)
DO YOU SUSPECT RSD?
"If the pain is out of proportion to the injury, there is stiffness and inflammation following a seemingly minor trauma e.g. twisted ankle, dropping item on foot, sprain , suspect RSD. The pain is described as burning, shooting, stabbing or a "hot poker". If the pain persists longer than the expected healing time of the injury, suspect RSD."
(from: Hooshmand, H MD CRPS: Diagnosis and Management Pain Digest Spring Verlager 1999).
TREATMENT IS CRUCIAL WITHIN THE 0-3 or 3-6 MONTHS when the disease responds best. It is essential that the person be referred to the proper specialist for treatment as soon as possible. After 6 months you can still receive treatment however avoid delays and see a specialist as soon as possible for best results.
DELAY IN TREATMENT COULD MEAN A LIFETIME OF CHRONIC PAIN for the patient. Without treatment, the disease could eventually become resistant to treatment.
There is also support sites available to share info and meet people with CRPS/RSD
ONE SUCH SITE IS CALLED" FIGHTING RSD" LOCATED AT>>>>>>>>>>>>
http://www.myrfn.com/fightingrsd/
