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RSD/CRPS

Complex Regional Pain Syndrome, or CRPS, formerly known as RSD or Reflex Sympathetic Dystrophy is a progressive disease of the nervous system, more specifically, the sympathetic nervous system. The pain is constant, severe, and out of proportion to the original injury. Typically the pain is accompanied by skin changes, swelling, extreme sensitivity, and can often be incapacitating. CRPS is one of the most painful forms of chronic pain that exists.

There are four main symptoms of CRPS:
  • Constant chronic burning pain – The pain feels as though it is literally on fire even though the affected area may feel cold to the touch to the patient. This symptom also includes extreme sensitivity to touch, temperature, sound, and vibration.
  • Inflammation – the appearance of the skin can be affected, bruising, mottling, tiny red spots, shiny, purplish in look; as well as affect the skin temperature of the affected area, cause excessive sweating, etc.
  • Spasms – in blood vessels (vasoconstriction) and muscles (sometimes referred to as rolling spasms) of the extremities.
  • Insomnia/Emotional Disturbance – includes the major changes in the brain such as short-term memory problems, concentration difficulties, confusion, sleep disturbances, etc.

There are many additional symptoms that can also occur over the course of the disease. Not all patients will have all of the symptoms and the symptoms may change over time because of the stage the patient is in, the treatments the patient is receiving, the medications they are taking and even such things as time of day/month/season, and whether or not they are currently under excess stress.

Treatment options

Sympathetic nerve block. Some individuals report short-term pain relief from sympathetic nerve blocks. Sympathetic blocks involve injecting an anesthetic next to the spine to directly block the activity of sympathetic nerves and improve blood flow.

Surgical sympathectomy. The use of this operation to destroy some of the nerves is controversial. Some experts think it is unnecessary and makes CRPS worse; others report a favorable outcome.

Spinal cord stimulation. This involves placing stimulating electrodes through a needle into the spine near the spinal cord provides a tingling sensation in the painful area. Usually the electrode is placed temporarily to assess whether stimulation will be helpful. Minor surgery is required to implant all the parts under the skin on the torso. Once implanted, the stimulator can be turned on and off, and adjusted using an external controller.

Other types of neural stimulation. Neurostimulation can be delivered at other locations along the pain pathway, not only at the spinal cord. The advantage is that no surgery is required; the disadvantage is need for repeated treatment sessions.

Intrathecal drug pumps. Pain-relieving medications are pumped directly into the fluid that bathes the spinal cord, usually opioids and local anesthetic agents such as clonidine and baclofen. The benefit is that pain-signaling targets in the spinal cord can be reached using doses far lower than those required for oral administration, which decreases side effects and increases drug effectiveness.

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