Complex Regional Pain Syndrome – CRPS
Dr. Howard Liss treats disorders that cause pain and disability by providing consultative services and soft tissue and joint injections when needed. When medically appropriate, he makes specific referrals for diagnostic testing (lab work, imaging, electrodiagnosis), physical and occupational therapy, interventional procedures (epidurals and facet joint injections), and surgery.
Encompassing a wide range of clinical conditions eliciting chronic pain, complex regional pain syndrome (CRPS) may develop following limb trauma with or without nerve damage. Even so, CRPS remains classified as a post-traumatic neuropathic pain disorder that can affect any body part, though it mainly occurs in the extremities.
Further investigation into the clinical relevance of CRPS requires some understanding of central sensitization, which is marked by an increased pain response and excitability in the neuron receptors outside the area of an injury. Simply put, central sensitization directly affects an individual’s perception of pain. This is important, as CRPS is believed to be a main contributor to complex regional pain syndrome (CRPS). Other factors associated with the onset of CRPS are trauma, immobilization, injections and surgery. The symptoms of CRPS may remain disproportionate to the severity of trauma. Even so, other clinical characteristics of CRPS include sensory, autonomic and motor disturbances, while stress and other psychological components play a role in the severity of pain.
The following injuries may provoke complex regional pain syndrome (CRPS):
- Nerve lesions
Symptoms and Conditions Related to Complex Regional Pain Syndrome – CRPS
Symptoms of complex regional pain syndrome generally move through three stages, though children with CRPS do not always follow the same pattern of symptoms. Marked by acute inflammation and sympathetic hypo-activity, the first stage of CRPS begins approximately 10 days following an injury or trauma. Pain may be more severe than anticipated, and there may be increased aching and discomfort due to physical impairment or emotional disturbances. Overall, individuals have a greater sensitivity to pain and become hyper-vigilant to the presence of changing sensations, and their pain threshold is lower. Around 3 months post-injury, stage 2 is characterized by worsening pain, along with burning and constant aching. Skin may appear glossy, thin or sweaty and joints may become stiff. Yet, stage 3 of CRPS is characterized by pain that has spread to the whole body, while fingertips and toes become atrophic and demineralization may be seen with an x-ray.
Symptoms of complex regional pain syndrome (CRPS) often spread beyond the area surrounding the original injury or trauma. Multiple body systems may be involved, and there are a large variety of related conditions, some of which include:
- Arterial insufficiency
- Bone fractures
- Conversion disorder
- Factitious disorder
- Nerve entrapment syndrome
- Peripheral neuropathies
- Rheumatoid arthritis
- Septic arthritis
Treatment and Management of Complex Regional Pain Syndrome – CRPS
Perhaps effective treatment and management of complex regional pain syndrome (CRPS) is best accomplished through a multidisciplinary approach in which careful screening and testing are administered to classify the full range of symptoms.
Providing optimal patient care for those with CRPS, physiatrists often consult other medical professionals including physical and occupational therapists, clinicians, psychologists and interventionists. Doing so provides a comprehensive framework for treatment. While initial treatment involves improving functioning for the affected limb, it’s important not to use ice therapy or compression for CRPS, as it restricts blood flow and circulation to the area. Rather, a selective combination of drug therapy and alternative techniques prove to release pressure off of joints, encouraging patients to move freely. Aqua therapy is one example of early physical therapy for complex regional pain syndrome. While the water provides just enough resistance to strengthen weakened muscles, the temperature of the water (which is often changed throughout therapy) helps patients overcome any sensitivity to temperature.
Under the direction of the physiatrist, physical therapists guide patients through a series of desensitization techniques, which prove to help patients reduce their sensitivity to touch. As patients progress through strength-building exercises and gain tolerance for noise, temperature and touch, they may engage in land-based exercises. These may closely mimic the patient’s daily activities and tasks and help them discern proper form and positioning while pacing their activity levels.
At the Howard Liss, M.D. Rehabilitation Institute in Tenafly, patients can rely on Dr. Liss to put together the right treatment, therapy and rehabilitation plan to ensure the most optimal outcome. Dr. Liss works closely with other specialists required to rehabilitate patients suffering from chronic pain or serious injuries, and Dr. Liss will refer patients as needed to ensure appropriate treatment. With extensive education and exposure to a variety of conditions that affect the cervical and lumbar spine, bones, nerves, joints, ligaments, tendons, muscles, brain, and spinal cord, Dr. Liss is uniquely positioned to help patients manage their pain and maximize their functioning.
Contact the Howard Liss, M.D. Rehabilitation Institute today to schedule a consultation with Dr. Liss.