Complex Regional Pain Syndromes ( Rsd)
Complex regional pain syndrome (CRPS) is a chronic progressive disease characterized by severe pain,
swelling and changes in the skin. Though treatment is often unsatisfactory, early multimodal therapy
can cause dramatic improvement or remission of the syndrome in some patients. The International
Association for the Study of Pain has proposed dividing CRPS into two types based on the presence of
nerve lesion following the injury.
Type I, formerly known as reflex sympathetic dystrophy (RSD), Sudeck's atrophy, reflex neurovascular
dystrophy (RND) or algoneurodystrophy, does not have demonstrable nerve lesions.
Type II, formerly known as causalgia, has evidence of obvious nerve damage.
The symptoms of CRPS usually manifest near the site of an injury, which is usually minor. The most
common symptoms overall are burning and electrical sensations, described to be like "shooting pain."
The patient may also experience muscle spasms, local swelling, abnormally increased sweating, changes
in skin temperature (usually hot but sometimes cold) and color (bright red or a reddish violet),
softening and thinning of bones, joint tenderness or stiffness, and/or restricted or painful movement.
The pain of CRPS is continuous and may be heightened by emotional or physical stress. Moving or touching
the limb is often intolerable. The symptoms of CRPS vary in severity and duration. There are three
variants of CRPS, previously thought of as stages. It is now believed that patients with CRPS do not
progress through these stages sequentially. These stages may not be time-constrained, and could possibly
event-related, such as ground-level falls or re-injuries in previous areas. It is important to remember
that often the parasympathetic nervous system is involved with CRPS, and a part (subset) of the
parasympathetic system is the autonomic (think automatic, like blood pressure regulation or breathing
or sweating) nervous system can go haywire and cause a wide variety of odd complaints that are not
mental in origin. Be sure and investigate autonomic dysfunction or disorder if you think you may have
one of the often distinct varieties of CRPS. Rather than a progression of CRPS from bad to worse, it
is now thought, instead, patients are likely to have one of the three following types of disease