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Complex regional pain syndrome

Complex regional pain syndrome (CRPS) is a group of symptoms which occurs very uncommonly after injury or surgery or prolonged joint immobilisation, and where excessive and non-typical pain is a prime feature.

The patient may experience -

• severe and continuing distressing pain - out of proportion to the insult
• swelling and stiffness
• localised skin discoloration
• localised burning pain of the skin with sensitivity to touch and temperature
• muscle wasting
• osteoporosis
• overgrown and grooved nails

Older names for the condition are still widely in use, especially 'Reflex Sympathetic Dystrophy' and 'Causalgia', but currently clinicians use CRPS and distinguish between CRPS I and CRPS II where in the latter a peripheral nerve problem exists in addition to the above symptoms. In addition there is a paediatric (childhood) form called RND (reflex neurovascular dystrophy).

CRPS is a very difficult condition to manage. It tends to come 'out of the blue' and distresses both patient and doctor. Key to treatment is early recognition of the problem - before the symptoms become recalcitrant. Pain out of proportion to the apparent problem, together with swelling and skin discoloration, should warn the doctor of the possibility of RSDS starting. In the early stages a thorough programme of management may abort the condition progressing to the full-blown condition.

The condition is generally managed symptom by symptom, with pain medication and mobilising physiotherapy taking main stage. Steroids, anti-depressents, acupuncture and sympathetic nerve block also form part of the armamentarium of treatment.

The condition may resolve spontaneously, or there may be periods of remission in a longer illness, or the condition may become chronic and disabling.