CRPS describes a painful debilitating condition in a limb such as the arm, hand, foot or leg, where the pain is out of proportion to any preceding injury and associated with reduced use of the limb. There are two types of CRPS:
- Type I – There is no evidence of nerve damage
- Type II – There is a history of nerve injury.
- Limb pain such as burning
- Allodynia (a non-painful stimulus that causes pain)
- Loss of fine motor control
- Tremors or spasms
- Changes to the skin, hair and nails of the affected limb (trophic changes)
- The affected limb may be colder or warmer than the unaffected limb
- The affected limb may be sweatier or drier than the unaffected limb
The syndrome is triggered by injury such as a sprain or strain, penetrating injury, fracture or surgery, or can occur spontaneously.
With the appropriate diagnosis and treatment, most people will recover from CRPS, but for some, there is a range of ongoing symptoms that vary from minor or severe. Relapses can happen for no known reason or can occur after injury/surgery for a separate reason.
CRPS is based on a clinical assessment. Investigations are only performed to exclude other diagnoses.
The “Budapest Criteria” for CRPS is considered the gold standard of assessment and diagnosis. The following criteria needs to be met:
- Continuing pain – extending past the usual or expected time frame of pain for any inciting event/injury
- Must report at least one of the symptoms in all four of the following categories and must display at least one sign at time of evaluation in two or more of the following categories:
- Sensory (reports or evidence of hyperaesthesia and/or allodynia)
- Vasomotor (Reports or evidence of Temperature asymmetry and/or skin colour changes)
- Sudomotor (Reports or evidence of oedema and/or sweating)
- Motor / trophic (Reports or evidence of a decreased range of motion/motor dysfunction such as tremor, weakness or dystonia and/or trophic changes to the skin, hair or nails).
Treatment of CRPS is guided by the patient’s presentation and the goal is to assist functional improvement. Successful treatment is multi-modal and includes:
- Pharmacology: Medications such as pain relievers and medications that work to treat nerve pain may also be recommended. These include medications such as anti-inflammatories, Panadol and in some cases stronger pain medications, although opioids should often be avoided. In some cases, if the patient is suitable and meets criteria, medicinal cannabis may also be suggested as a trial. Medications that target nerve pain (and often used to treat epilepsy or depression) may also be prescribed. These include Lyrica, Gabapentin or Amitriptyline for example.
- Exercise Physiotherapy / Physical Therapy: Physiotherapists and occupational therapists have a key role in the treatment and management of CRPS. Treatment aims include desensitisation, hydrotherapy, strengthening, sensory re-education/ exposure therapy and oedema control.
- Psychological Support: Depression, anxiety, fear of movement and harm/re-injury are common in patients who experience CRPS. Psychological interventions attempt to work through these issues and specific therapies tailored to ensure these issues are addressed using a variety of techniques such as mindfulness, relaxation, active coping strategies and cognitive behavioural therapy.
- Interventional Procedures: Your pain specialist may recommend therapies such as specialised creams, infusions such as Lignocaine, Ketamine or Zoledronic Acid. In some cases, interventional procedures or advanced pain therapies such as stimulators may also be recommended. More information will be provided to you if you are recommended for one of these treatments.
It is important to note that CRPS affects people in different ways and one person’s response to treatment will be different from another person’s. Your pain specialist will work out a plan on how best to treat you and your symptoms.
**This information sheet has been written for patients affected by CRPS and provides general information only**
References: Australian Prescriber; Pain Australia; Better Health Victoria.