What is CRPS?

This is the description on the NHS website that I have adapted(http://www.nhs.uk/Conditions/Complex-Regional-Pain-Syndrome)  :-
Complex regional pain syndrome (CRPS) is a poorly understood condition in which a person develops a persistent (chronic) burning pain in one of their limbs.....The skin of the affected body part can become very sensitive, and even the slightest touch, bump, or change in temperature can provoke a feeling of intense pain....
CRPS can cause other symptoms, including:
  • alternating changes in skin temperature – sometimes your skin may feel sweaty, other times cold and clammy
  • changes in skin colour – your skin tone may range from pale and colourless to pink, or may have a blue tinge and appear blotchy or streaky
  • changes in skin texture – your skin may appear shiny and thin
  • changes in the way your hair and nails grow – either unusually slowly or quickly
  • swelling, pain and stiffness in the affected joints
  • increasing difficulty moving the affected body part
The treatment of complex regional pain syndrome (CRPS) usually involves a combination of physical treatment methods and medication to manage pain. 
Many experts feel that physiotherapy is the most important factor in treating CRPS. Your treatment team will try lower-strength painkillers first, and will only use stronger painkillers if necessary. Alternatively, a short-term course of strong painkillers may be used to enable you to start physiotherapy. Once you begin to respond to physiotherapy, you move on to weaker painkillers.

Helping you cope better with the emotional impact of living with pain is also an important part of treatment...
 
The first type of painkillers often used to treat CRPS are over-the-counter (OTC) painkillers called non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen.
Anticonvulsants were originally designed to treat epilepsy. However, they have also been found to be useful for treating nerve pain. Gabapentin is the most widely used anticonvulsant for treating CRPS.
Tricyclic antidepressants (TCAs) were originally designed to treat depression, but like anticonvulsants were found effective in treating nerve pain. Amitriptyline is the most widely used TCA for treating CRPS.
If you are experiencing severe pain, opiates such as codeine and morphine can be used to provide short-term relief.
Nerve blocks are often used to provide short-term pain relief for people with CRPS.
 
The Pain Management Centre that I visit is in National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG. Complex Regional Pain Syndrome, or CRPS as it is referred to, is pain that is constant. It often affects a hand/arm or foot/leg. It most commonly starts after an injury or operation. It can be a minor injury and sometimes, rarely, it starts without any known reason. It affects more women than men and it also affects children. It used to be called Reflex Sympathetic Dystrophy, or RSD, and causalgia, and is sometimes still referred to as these (alongside some other names).

A syndrome is a collection of symptoms without a known cause. You do not have to have all these symptoms to have CRPS. The affected limb may have:

  • pain or sensations constantly, e.g. pins and needles, burning, stinging, sharp, etc
  • skin colour changes,
  • changes in hair/nails; nails may break easily, hair may be fine, may stop growing
  • variation in skin temperature, it may feel cold/hot to the touch
  • unusual sweating
  • pain being caused by things that you wouldn’t expect to cause pain,  (allodynia/hyperalgesia)
  • tremors
  • muscle contractions causing unusual movements and postures (dystonia)
  • fluid build-up causing swelling (edema)
  • lower bone density as they become more porous (osteoporosis)

  • The symptoms also include:

  • reduced response to stimulation of nerves/body areas, responses can vary from one half of the body to the other (hemi-body hypoethesia)
  • problems with the Central Nervous System (CNS). The CNS is made up of the brain and spinal cord which use the information from the wider spread Autonomic Nervous System (ANS) to control and co-ordinate what we do. The CNS can do some odd things when it’s dependent on a faulty ANS for it’s information.
  • avoiding using the part of the body which hurts, which then causes additional problems like the muscles starting to waste away through lack of use (atrophy)
  • It can also sometimes spread - to the opposite limb, to the same side limb, to the diagonal limb. It can also spread to internal areas in all sorts of ways and the latest piece of research I've found on this is Systemic complications of complex regional pain syndrome by Robert J. Schwartzman.

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