The first thing to say is that, from what my clients have told me over many years of handling CRPS cases, the symptoms can vary enormously from one person to another.
Some people suffer very badly to such an extent that it causes intense continuous pain; extreme fatigue; loss of mobility; and depression. Others people might be luckier, but CRPS can still have a significant impact upon their daily lives.
In simple terms, Complex Regional Pain Syndrome arises when the body produces an abnormal response to an injury.
The injury itself may have been fairly modest but the body’s reaction goes in to over-drive. CRPS can also occur following what might otherwise have been a routine medical procedure such as some form of surgery or other invasive, but necessary, treatment. This situation can be particularly distressing. The patient goes in to hospital for what they think is some fairly safe and routine treatment. The treatment itself is a complete success, but the patient comes away with a much worse condition than they started with i.e. CRPS.
A few years ago, Complex Regional Pain Syndrome was often referred to as Reflex Sympathetic Dystrophy, Causalgia, or Sudeck’s Atrophy. They were all chronic pain conditions.
According to the International Association for the Study of Pain (IASP), a victim of CRPS is likely to have the following symptoms:
- Ongoing pain which appears to be disproportionate to the event which caused it. This pain can be in the form of Allodynia. This means that pain can come from something that wouldn’t usually be painful such as a light touch of the skin, or it can be an abnormal amount of pain caused by an increased level of response to some other less painful event (known as Hyperalgesia).
- A history of fluid retention (known in medical terms as Oedema), or changes in blood flow in and around the skin.
In order to make a diagnosis of CRPS all pain specialists and doctors use the Budapest Criteria 2004 which was developed at the International Consensus Conference 2004. The IASP has adopted the Budapest Criteria.
Broadly speaking, the Budapest Criteria says that all of the following symptoms must be present in order to make a diagnosis of CRPS:
- Continuing pain which is disproportionate to the event that caused it
- The patient has at least one sign in 2 or more of the following categories:
- Sensory – increased pain or temperature sensations.
- Vasomotor – skin colour or regionalised temperature changes.
- Sudomotor/Oedema – fluid retention or abnormal sweating.
- Motor/Trophic – decreased range of movement or weakness, and changes to the hair, nails, or skin.
- The patient also reports at least 1 symptom in 3 or more of the above categories.
- That there is no other diagnosis that can better explain the signs and symptoms.
CPRS is usually divided in to 2 types. Type 1 is more common and does not involve damage (lesion) to a major nerve. Type 2 arises when there is evidence of some major nerve damage. Whether the CRPS is type 1 or type 2, it doesn’t make much difference to the overall approach to treatment.
CRPS usually affects one limb, but it can spread to other limbs.
The patient’s level of pain is nearly always the main cause for concern. It is usually associated with limb dysfunction and psychological symptoms. It is not the least bit surprising that continuing pain and physical difficulties can quickly lead to emotional distress.