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Chronic Pain, Pain Relief, Peripheral Neuropathy, Nerve Pain Treatment, Pain Management, Carolina Pain Scrambler, Greenville South Carolina

Chronic Pain Syndrome

What is a chronic pain syndrome?

Your doctor has told you that you have a chronic pain syndrome. What does it mean?

In most cases, chronic pain starts with an acute injury or illness. If the pain of this injury or illness lasts longer than six months, it’s then considered chronic pain. Sometimes, chronic pain subsequently causes complications. These complications, in turn, can make the pain worse. A chronic pain syndrome is the combination of chronic pain and the secondary complications that are making the original pain worse.

Chronic pain syndromes develop in what we call a vicious cycle. A vicious cycle is the cycle of pain causing pain: chronic pain that causes secondary complications, which subsequently make the original chronic pain worse.

What are these secondary complications? Chronic pain can lead to some common problems over time. For example, many people tend to have trouble sleeping because of pain. After a while, they are so tired and their patience has worn so thin that everything starts bugging them. They also find that coping with chronic pain gets harder and harder too. Some people stop working. With the job loss, they might come to experience financial problems. The stress of these problems keeps them up at night. Thinking too much in the middle of the night can make the original sleeping problem even worse. It can be hard to shut off the thinking even in the middle day. Chronic pain can also affect the roles people have in the family. They miss out on children’s activities, family functions, and parties with friends. As a result, many people struggle with guilt. Guilt isn’t the only emotion that is common to living with chronic pain. Patients tend to report some combination of fear, irritability, anxiety and depression. Patients also tend to express that they have lost their sense of direction to life. They are stuck. These problems are all common when living with chronic pain.

These problems cause stress. They are called stressors, which means that they are problems that cause stress. These stressors can make pain worse because stress affects the nervous system.It makes the nervous system more reactive and you become nervous. Now, pain is also a nerve related problem. Whatever its initial cause, pain travels along the nervous system to the brain, which is also part of the nervous system. Once reaching the brain, it registers as pain. When stress affects the nervous system, making it more reactive, the pain signals reach the brain in an amplified way. So, stress leads you to have more pain.

The vicious cycles of pain become clear. Chronic pain causes stressful problems, which, in turn, cause stress that makes the pain worse. This combination of chronic pain and the resultant problems that make pain worse is what we call a chronic pain syndrome.

Article Provided By: Institute of Chronic Pain

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If you would like to discuss what Carolina Pain Scrambler do to help relieve your chronic pain symptoms or receive more information on our treatment process, please do not hesitate to call us at 864-520-5011 or you can email us at info@carolinapainscrambler.com
CRPS, Complex Regional Pain Syndrome, Pain Relief, Pain Therapy, Carolina Pain Scrambler, Greenville South Carolina, Peripheral Neuropathy

Complex Regional Pain Syndrome

What is complex regional pain syndrome?

Complex regional pain syndrome (CRPS) is an uncommon nerve-related pain condition. While it can occur in any body part, it usually occurs in an arm or leg. It has a typical set of signs and symptoms in the affected body part:

  • Persistent burning pain
  • Sensitivity to touch and/or cold
  • Changes in skin color (to the color red or even a shade of purple)
  • Swelling
  • Changes in skin temperature
  • Changes in hair and nail growth

The pain of CRPS is often intense. Patients tend to exhibit a touch-me-not reaction of vigilance and alarm to the mild touch of others or even to the wind blowing on the affected part of the body. As such, patients often limit activity and hold the affected part in a rigid and motionless manner. In addition to being impairing, the persistent sense of vigilance and alarm naturally lead to emotional distress.

There is no known cause of CRPS. It likely involves the sympathetic nervous system. The sympathetic nervous system also affects immune system functioning. As such, the sympathetic nervous system likely has something to do with the inflammation that causes the swelling and changes in skin color. The cause of CRPS also likely involves the central nervous system – the brain and spinal cord. Among other functions, the central nervous system processes nerve impulses from the affected body part. Because of the high sensitivity to touch and cold that occurs, the amplification of these signals suggests that there is some type of problem in the information processing functions of the central nervous system.

Despite having no known cause, CRPS often starts with surgeries or injuries – even mild injuries — to the affected body part. Obviously, however, there must be more to the picture when it comes to causes of CRPS, as most surgeries and mild injuries do not typically lead to CRPS.

There are two types of complex regional pain syndrome. These types are based on the different kinds of injuries that can precipitate CRPS. They are referred to as complex regional pain syndrome I and complex regional pain syndrome II.

  • Complex regional pain syndrome I: Presumed injury to the sympathetic nervous system in the affected body part. This type used to be called ‘reflex sympathetic dystrophy (RSD).’
  • Complex regional pain syndrome II: Actual injury to a nerve in the affected body part due to a surgery or injury. This type used to be called ‘causalgia.’

Complex regional pain syndrome I is the most common form of CRPS.

Is there a cure for complex regional pain syndrome?

The course of CRPS can vary across different individuals. Conventional wisdom in the healthcare community is that CRPS can be cured if caught early, but will become chronic if not caught early. This notion comes from anecdotal evidence that CRPS can sometimes be cured through early interventions. However, there are no well-designed, published research data that clearly supports this view.

CRPS can progress beyond the original affected body part. It can come to affect other limbs or indeed the whole body. Central sensitization likely plays a role in this progression.1 Central sensitization is a highly reactive state of the nervous system, which amplifies pain.

Typically, CRPS I and II are chronic pain disorders. Chronic conditions are health conditions that have no cure and which tend to last indefinitely. Healthcare for chronic conditions focuses on reducing symptoms and reducing the impact that the condition has on the patient’s life. The goal is to still live well despite having the condition.

Therapies & Procedures for complex regional pain syndrome

Common treatments for CRPS I & II are anti-inflammatory medications, corticosteroid medications, antidepressant medications, anticonvulsant medications, bisphosohonates, calcitonin, physical therapy, nerve blocks, neural blockades, spinal cord stimulation, and chronic pain rehabilitation programs.

Recent published reviews of research express concern about how there are no well-designed studies of the effectiveness for any of these common treatments.2, 3 Despite how often they are pursued, their effectiveness are all unproven. Both reviews indicate that there are limited data to suggest bisphosphonates can be helpful. Quisel, et al., suggest that calcitonin and chronic pain rehabilitation program are likely to be helpful. They also report that spinal cord stimulation shows some promise but should only be pursued after considerable consultation due to the invasive nature of the procedure.

Article Provided By: Institute of Chronic Pain

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If you would like to discuss what Carolina Pain Scrambler do to help relieve your chronic pain symptoms or receive more information on our treatment process, please do not hesitate to call us at 864-520-5011 or you can email us at info@carolinapainscrambler.com
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Manage Brain Fog From Chronic Pain

Do you find that you’re more forgetful or fuzzy-headed when you are in pain? Is it harder to concentrate? Like many with chronic pain, you may be experiencing signs of brain fog, also known as cognitive dysfunction. If this is happening to you, rest assured you are not alone.“Cognitive function” is a variety of mental activities including memory, learning, problem solving, decision making, and attention. Over the past decade, people have come to learn that the experience of pain can play a big role in how well people perform these mental activities, and the more intense the pain and the more body parts that are affected, the more disruptive it seems to get.Perhaps the best-known example of this is “fibro fog,” which is a term commonly used by those with fibromyalgia to describe the cognitive difficulties they experience on a daily basis. Common complaints of fibro fog include forgetfulness, poor concentration, difficulty finding words, and trouble carrying on a conversation. But this feeling of mental cloudiness can occur with other chronic pain syndromes as well, including migraines, back pain, and painful nerve disorders like diabetic neuropathy and complex regional pain syndrome (CRPS).
Research has shown that chronic pain can interfere with a variety of cognitive functions, with the most recognizable being memory. Chronic pain is associated with greater recall problems for words and information, as well as for objects and places, also known as spatial memory. The more widespread the pain is in the body, the bigger the memory deficits. Pain has also been shown to interfere with how well people concentrate and stay on task, as well as their ability to organize their thoughts (known as executive function). For example, pain seems to interfere with the brain’s ability to adapt to change when performing tasks.
Other factors related to pain can also contribute to brain fog, including depression and anxiety. Insomnia, also highly associated with chronic pain, can reduce mental sharpness and cognitive performance.

Researchers are still trying to better understand the causes of this brain fog, but one possible explanation may be found in research suggesting that a brain in pain is over-activated and over-stressed. Parts of the brain that would normally get time to rest don’t get a break with chronic pain, resulting in changes to how well the brain can store information and perform executive functions. It is much harder to have a conversation with someone when there are a bunch of other people in the room talking to you at the same time. Experiencing pain may create a lot of extra brain noise, making it that much harder to focus.

So, if experiencing pain seems to leave you with brain fog, what can you do? One way you may be able to decrease brain fog is by clearing out some of this extra unwanted background noise. One proven way to do this is through meditation. Mindfulness meditation training boosts focus while calming the nervous system, which can lead to improved cognitive performance and less brain fog. Distraction can also help dampen some of this background interference. Simple distraction tricks can include listening to music, journaling, drawing, or coloring. And a lot has been published on the powerful effects that exercise can have on brain performance, even in old-age. Research has found that exercise stimulates the production of a protein called brain derived neurotrophic factor which has been shown to boost mental function and improve both depression and anxiety.Along with trying out some of these tools, consider taking notes and making lists to help be prepared for moments of cloudiness or forgetfulness. Carrying a notepad with critical information (like your medication list) to places like doctor appointments or when running errands can help remind you of what is most important. Improving brain function is still an active area of research, so hopefully we’ll see more helpful treatments on the horizon soon.
Article Provided By: WebMD

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If you would like to discuss what Carolina Pain Scrambler do to help relieve your chronic pain symptoms or receive more information on our treatment process, please do not hesitate to call us at 864-520-5011 or you can email us at info@carolinapainscrambler.com
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5 Things to Know About Chronic Pain

If you suffer from chronic pain, it’s important that your friends and family know what you’re going through. With this in mind, here are 5 things to know about chronic pain that you can share with your loved ones:

1. Chronic pain is real

People with chronic pain are often treated as if they are making up (or at least exaggerating) their pain. But the truth is that all pain is real, even if there is no known cause. Additionally, almost all people with chronic pain want nothing more than to be pain-free.

So what your friend or family member needs from you is your support and kindness, not condemnation. Statements like “Get over it” or “It can’t be that bad” don’t accomplish anything other than to discourage those with chronic pain.

Thankfully, there is an increasing consensus in the medical community that all chronic pain is real, and that it needs to be treated even if there is no known cause.

2. Chronic pain commonly leads to disuse syndrome

Chronic pain often leads to long-term lack of physical activity and a condition recognized as disuse syndrome. This syndrome can negatively impact your musculoskeletal, cardiovascular, neurological, psychological, and emotional processes. At its worst, disuse syndrome leads to a pervasive lack of wellness that in and of itself can be debilitating.

Of note, disuse syndrome can both perpetuate and increase the likelihood of chronic pain worsening over time.

3. Chronic pain commonly leads to sleep-related problems

Chronic pain can create a troubling cycle when it comes to sleep. That is, chronic pain can make it harder to sleep, and in turn a lack of sleep can make chronic pain worse.

Common sleep-related problems caused by chronic pain include an inability to fall asleep, constantly waking up at night, and not feeling refreshed upon waking up in the morning. Because of the close connection between sleep problems and chronic pain, the two need to be treated together.

4. Pain is deeply personal

Everyone persons experience of pain is different. For example, two people may have the same condition, and one may display no ill-effects, while the other may be incapacitated. When it comes to back pain, this is especially true. Two people can have the same type of herniated disc, but one feels only slight discomfort and the other feels burning, debilitating sciatic pain.

There are a number of possible reasons for this, including individual physiology, a person’s upbringing, etc.

5. Happiness does not equal health

Often times, when a person with chronic pain is smiling or having a “good day,” people assume that the person is not experiencing pain. However, this is not necessarily the case.

It is important to recognize that a person can be happy and at the same time be experiencing pain. So be careful to not assume that a friend or loved one is “healed” simply because they seem to be enjoying themselves.

The bottom line

There are so many secondary and related issues that accompany chronic pain that it would be a real challenge to address them all. This list is intended to at least get the conversation started—and for anyone living with any type of chronic pain , please pass this along to your loved ones to help them better understand and support you.

If you have chronic pain, your may also find it does you a world of good to have increased emotional support, more effective and sustainable pain management, and even possibly harnessing the power of your mind to assist in coping with the pain.

Article Provided By: Spine Health

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If you would like to discuss what Carolina Pain Scrambler do to help relieve your chronic pain symptoms or receive more information on our treatment process, please do not hesitate to call us at 864-520-5011 or you can email us at info@carolinapainscrambler.com
CRPS, Complex Regional Pain Syndrome, Pain Relief, Pain Therapy, Carolina Pain Scrambler, Greenville South Carolina, Peripheral Neuropathy

CRPS Facts and Information

CRPS

A Chronic, Progressive, Painful Condition Affecting the Skin, Muscles, Joints, and Bones

Chronic arm or leg pain developing after injury, surgery, stroke, or heart attack.

CRPS Facts & Information

Potential causes of CRPS range from minor injuries, such as a sprain, to severe injuries, such as damage to a nerve. Even relatively long periods of immobility, such as would occur with a broken leg, can result in CRPS.

The symptoms of CRPS frequently include severe burning pain and extreme sensitivity to touch in the area of the injury. Swelling, excessive sweating, and changes in the bone and skin tissue may also occur. If you’re experiencing these symptoms, it’s important to seek early intervention.

The nation’s leader in pain management, National Spine & Pain Centers has board-certified doctors who are highly skilled in accurately diagnosing CRPS and customizing non-surgical treatment plans that offer lasting relief.

How & Why Does CRPS Develop?

CRPS, also referred to as Reflex Sympathetic Dystrophy (RSD) and Causalgia, is usually caused by an injury to the bones, joints, tissue, or nerves. The original injury can be severe, such as a broken bone, or minor, such as a sprain. In the case of an injury, CRPS symptoms may not appear right away. As described above, these symptoms can result in extreme discomfort. Stress often increases the severity of pain. As with any injury or condition, paying attention to the messages your body sends you and seeking treatment from knowledgeable medical professionals is critical.

It most often occurs in adults between the ages 20-40 and generally affects women more than men.

CRPS can result from several different causes. Research suggests that the symptoms may result from an injured nerve or nerves. The nerves send normal pain signals that pass through the spinal cord and are then transmitted to the brain. The problems occur because the spinal cord begins to send confusing signals to the brain, as well as to the injured area itself.

These confused signals interfere with normal blood flow and sensory signals resulting in extreme pain. In some cases, an immune response is triggered causing sweating, redness, inflammation, warmth, and/or muscle spasms.

Symptoms

Symptoms may spread upward from the initial injury site (e.g. hand to shoulder) and may be heightened by emotional stress. The unrelenting pain causes many people extreme emotional and physical duress and, left untreated, can lead to permanent changes in muscle and bone. Early detection and treatment are very much needed. Common symptoms include:

  • Swelling
  • Muscle spasms
  • Loss of motion
  • Abnormal sweating
  • Tenderness and stiffness in joints
  • Extreme sensitivity to even mild stimuli, such as clothing or a light touch
  • Warm, red-looking skin at the injured area initially, changing to cool, bluish-looking skin later

Diagnosis

Proper diagnosis starts with an experienced pain management doctor. The type of pain that you may have with CRPS can be similar to the symptoms of several types of disorders. Accurately determining the correct source of your pain is critical to successful treatment. Diagnosis involves the following:

  • Begins with a thorough clinical evaluation
  • Including a complete medical history, analysis of your symptoms, and physical examination
  • Testing may include x-rays, MRI and/or CT scans, and electro-diagnosis (EMG)
  • These advanced diagnostic techniques definitively pinpoint the source of pain

Article Provided By: Advanced Medical Group

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If you would like to discuss what Carolina Pain Scrambler do to help relieve your chronic pain symptoms or receive more information on our treatment process, please do not hesitate to call us at 864-520-5011 or you can email us at info@carolinapainscrambler.com
CRPS, Complex Regional Pain Syndrome, Pain Relief, Chronic Pain, Pain Therapy, Pain Management, Carolina Pain Scrambler Center, Greenville South Carolina

Telltale Signs of CRPS/RSD

You are likely researching CRPS/RSD because you or a loved one are experiencing unexplained moderate-to-severe pain and are trying to find the cause. Perhaps a Google search of the symptoms got you to this page. You may have already visited one or more physicians.

A physician may have suggested that your symptoms could possibly be CRPSComplex Regional Pain Syndrome – or, RSD – Reflex Sympathetic Dystrophy, but that they do not specialize in this condition. You are on a journey for a concrete diagnosis.

First of all, you may or may not have CRPS/RSD. There are a number of conditions that have serious, chronic pain as a symptom, along with others that are also present in CRPS/RSD. Here you can learn more about this condition and its symptoms to help you and your doctor rule it in — or rule it out.

What is CRPS/RSD?

CRPS/RSD is a chronic neuro-inflammatory disorder. It is classified as a rare disorder by the United States Food and Drug Administration. However, up to 200,000 individuals experience this condition in the United States, alone, in any given year.

CRPS occurs when the nervous system and the immune system malfunction as they respond to tissue damage from trauma. The nerves misfire, sending constant pain signals to the brain. The level of pain is measured as one of the most severe on the McGill University Pain Scale.

CRPS generally follows a musculoskeletal injury, a nerve injury, surgery or immobilization.

The persistent pain and disability associated with CRPS/RSD require coordinated, interdisciplinary, patient-centered care to achieve pain reduction/cessation and better function.

It has been shown that early diagnosis is generally the key to better outcomes. However diagnosing CRPS/RSD is not a simple matter and many patients search for months or years for a definitive diagnosis.

It is important to know that research has proven that CRPS/RSD is a physical disorder. Unfortunately, it has not been unusual for medical professionals to suggest that people with CRPS/RSD exaggerate their pain for psychological reasons. Trust your body and continue to seek a diagnosis. If it’s CRPS/RSD, the pain is not in your mind!

Making the Diagnosis

There is no single diagnostic tool for CRPS/RSD. Physicians diagnose it based on patient history, clinical examination, and laboratory results. Physicians must rule out any other condition that would otherwise account for the degree of pain and dysfunction before considering CRPS/RSD.

Early diagnosis and appropriate treatment offer the highest probability of effective treatment and possible remission of CRPS/RSD.

CRPS/RSD Signs and Symptoms Checklist

There is no gold standard for diagnosing CRPS/RSD. If the pain is getting worse, not better, and if the pain is more severe than one would expect from the original injury, it might be CRPS/RSD.

Look for these telltale signs and symptoms:

  • Pain that is described as deep, aching, cold, burning, and/or increased skin sensitivity
  • An initiating injury or traumatic event, such as a sprain, fracture, minor surgery, etc., that should not cause as severe pain as being experienced or where the pain does not subside with healing
  • Pain (moderate-to-severe) associated with allodynia, that is, pain from something that should not cause pain, such as the touch of clothing or a shower
  • Continuing pain (moderate-to-severe) associated with hyperalgesia, that is, heightened sensitivity to painful stimulation)
  • Abnormal swelling in the affected area
  • Abnormal hair or nail growth
  • Abnormal skin color changes
  • Abnormal skin temperature, that is, one side of the body is warmer or colder than the other by more than 1°C
  • Abnormal sweating of the affected area
  • Limited range of motion, weakness, or other motor disorders such as paralysis or dystonia
  • Symptoms and signs can wax and wane
  • Can affect anyone, but is more common in women, with a recent increase in the number of children and adolescents who are diagnosed

Please keep in mind that this information is not intended as medical advice, nor is it a substitute for a diagnosis by a qualified, medical professional. Please feel free to share the information with your doctor or doctors.

Article Provided By: RSDSA

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If you would like to discuss what Carolina Pain Scrambler do to help relieve your chronic pain symptoms or receive more information on our treatment process, please do not hesitate to call us at 864-520-5011 or you can email us at info@carolinapainscrambler.com
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Symptoms and Causes of CRPS

Following an injury or surgery, even something as simple as a sprained ankle, some people begin experiencing intense pain that seems to spread from the injury and makes the entire limb feel on fire or as if electrical shocks are running up and down the area. Often, doctors diagnose these individuals with complex regional pain syndrome (CRPS), a condition for which there are many causes and symptoms.

1. What is Complex Regional Pain Syndrome?

Complex regional pain syndrome is a rare condition that can occur after surgery, stroke, heart attack, or an injury. It is thought to be an unusual autoimmune response to the trauma. Unfortunately, this pain is often more impactful than the injury or preceding illness itself.

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2. What Causes Complex Regional Pain Syndrome?

Complex regional pain syndrome is believed to be caused by the malfunction of, or from damage to, the peripheral and central nervous systems, combined with the immune response. The pain causes the immune system to overreact, resulting in swelling and stiffness in the affected joints. The initial cause is the trauma, which leads to a cascade of events resulting in complex regional pain syndrome.

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3. How Long Does Complex Regional Pain Syndrom Last?

Complex regional pain syndrome is often a chronic condition lasting more than six months. You may experience symptoms for a while and go into remission, only to have the condition flare up again at a later date. CRPS will affect some people just once and never again, while others are in constant pain and need treatment regularly.

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4. What are the Symptoms of Complex Regional Pain Syndrome?

Complex regional pain syndrome manifests itself in several ways. You may feel constant dull or severe pain, or feel electric shocks or “pins and needles”; others describe the pain as burning and intense. Some people with CRPS have difficulty moving the affected limb, or the pain may travel to the opposite limb, as well. You may experience sweating in the affected area, where the skin may appear thin and shiny. Some people notice changes to hair and nail growth patterns and have tremors or jerking in the limb. Lastly, the affected limb may change color, becoming purple, red, blue, blotchy, or pale.

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5. How Does a Doctor Diagnose Complex Regional Pain Syndrome?

There is no one test that definitively diagnoses complex regional pain syndrome. Instead, your doctor will look at your past case history and your symptoms and make an evaluation. He or she may run tests to rule out other diseases since the symptoms of complex regional pain syndrome mimic other diseases with different treatments.

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6. Are There Different Types of Complex Regional Pain Syndrome?

There are two types of complex regional pain syndrome: type 1 and type 2. Most people (90 percent) have type 1 complex regional pain syndrome. Also called reflex sympathetic dystrophy syndrome or RSD, it occurs following trauma that did not damage the nerves. Type 2 or causalgia occurs when the trauma damages the nerves.

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7. Complications of Complex Regional Pain Syndrome?

If you fail to receive treatment for CRPS, you could experience severe complications including atrophy and muscle contraction. Atrophy causes your muscles, skin, and bones deteriorate due to lack of use. Affected extremities become weakened to the point where they cannot be used at all. Alternatively, your muscles may begin to contract, fixing the injured body part in one position, again rendering the limb unusable.

 

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8. How is Complex Regional Pain Syndrom Treated?

There are many options for treating complex regional pain syndrome. Your doctor may prescribe physical therapy, medications, and psychotherapy. You may find some relief from sympathetic nerve blocks, spinal cord stimulation, neurostimulation, intrathecal drug pumps, or Graded Motor imagery. Some people find alternative therapies helpful and turn to acupuncture, chiropractic, and biofeedback for relief. Other modalities that work toward relaxing the limb include behavior modification, relaxation techniques, progressive muscle relaxation, and guided motion therapy.

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9. Who is At Risk of Complex Regional Pain Syndrome?

Complex regional pain syndrome may affect anyone at any age, but the median age is 40. Children and adults younger than 30 have been known to develop CRPS. Women seem to develop the condition more than men, but men can get it, too. Anyone who has had an injury is at risk, especially if the injury affects the extremities.

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10. What is the Prognosis for Recovery from Complex Regional Pain Syndrome?

The earlier CRPS is diagnosed and treated, the better the prognosis. Younger people, especially those under the age of 20 are more likely to recover from complex regional pain syndrome than older individuals. However, the disorder is different for everyone and some people deal with chronic pain and disability, even with treatment.

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Article Provided By: FactyHealth

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Complex Regional Pain Syndrome Facts

What is complex regional pain syndrome?

Complex regional pain syndrome (CRPS) is a chronic (lasting greater than six months) pain condition that most often affects one limb (arm, leg, hand, or foot) usually after an injury.  CRPS is believed to be caused by damage to, or malfunction of, the peripheral and central nervous systems.  The central nervous system is composed of the brain and spinal cord; the peripheral nervous system involves nerve signaling from the brain and spinal cord to the rest of the body.  CRPS is characterized by prolonged or excessive pain and changes in skin color, temperature, and/or swelling in the affected area.

CRPS is divided into two types:  CRPS-I and CRPS-II. Individuals without a confirmed nerve injury are classified as having CRPS-I (previously known as reflex sympathetic dystrophy syndrome).  CRPS-II (previously known as causalgia) is when there is an associated, confirmed nerve injury.  As some research has identified evidence of nerve injury in CRPS-I, it is unclear if this disorders will always be divided into two types.  Nonetheless, the treatment is similar.

CRPS symptoms vary in severity and duration, although some cases are mild and eventually go away.  In more severe cases, individuals may not recover and may have long-term disability.

Who can get CRPS?

Although it is more common in women, CRPS can occur in anyone at any age, with a peak at age 40.  CRPS is rare in the elderly. Very few children under age 10 and almost no children under age 5 are affected.

What are the symptoms of CRPS?

The key symptom is prolonged severe pain that may be constant.  It has been described as “burning,” “pins and needles” sensation, or as if someone were squeezing the affected limb.  The pain may spread to the entire arm or leg, even though the injury might have only involved a finger or toe. In rare cases, pain can sometimes even travel to the opposite extremity.  There is often increased sensitivity in the affected area, known as allodynia, in which normal contact with the skin is experienced as very painful.

People with CRPS also experience changes in skin temperature, skin color, or swelling of the affected limb.  This is due to abnormal microcirculation caused by damage to the nerves controlling blood flow and temperature.  As a result, an affected arm or leg may feel warmer or cooler compared to the opposite limb.  The skin on the affected limb may change color, becoming blotchy, blue, purple, pale, or red.

Other common features of CRPS include:

  • changes in skin texture on the affected area; it may appear shiny and thin
  • abnormal sweating pattern in the affected area or surrounding areas
  • changes in nail and hair growth patterns
  • stiffness in affected joints
  • problems coordinating muscle movement, with decreased ability to move the affected body part
  • abnormal movement in the affected limb, most often fixed abnormal posture (called dystonia) but also tremors in or jerking of the limb.

What causes CRPS?

It is unclear why some individuals develop CRPS while others with similar trauma do not.  In more than 90 percent of cases, the condition is triggered by a clear history of trauma or injury.  The most common triggers are fractures, sprains/strains, soft tissue injury (such as burns, cuts, or bruises), limb immobilization (such as being in a cast), surgery, or even minor medical procedures such as needle stick. CRPS represents an abnormal response that magnifies the effects of the injury.  Some people respond excessively to a trigger that causes no problem for other people, such as what is observed in people who have food allergies.

Peripheral nerve abnormalities found in individuals with CRPS usually involve the small unmyelinated and thinly myelinated sensory nerve fibers (axons) that carry pain messages and signals to blood vessels. (Myelin is a mixture of proteins and fat-like substances that surround and insulate some nerve fibers.) Because small fibers in the nerves communicate with blood vessels, injuries to the fibers may trigger the many different symptoms of CRPS.  Molecules secreted from the ends of hyperactive small nerve fibers are thought to contribute to inflammation and blood vessel abnormalities.  These peripheral nerve abnormalities trigger abnormal neurological function in the spinal cord and brain.

Blood vessels in the affected limb may dilate (open wider) or leak fluid into the surrounding tissue, causing red, swollen skin.  The dilation and constriction of small blood vessels is controlled by small nerve fiber axons as well as chemical messengers in the blood.  The underlying muscles and deeper tissues can become starved of oxygen and nutrients, which causes muscle and joint pain as well as damage.  The blood vessels may over-constrict (clamp down), causing old, white, or bluish skin.

CRPS also affects the immune system. High levels of inflammatory chemicals (cytokines) have been found in the tissues of people with CRPS.  These contribute to the redness, swelling, and warmth reported by many patients. CRPS is more common in individuals with other inflammatory and autoimmune conditions such as asthma.

Limited data suggest that CRPS also may be influenced by genetics.  Rare family clusters of CRPS have been reported.  Familial CRPS may be more severe with earlier onset, greater dystonia, and more than one limb being affected.

Occasionally CRPS develops without any known injury.  In these cases, an infection, a blood vessel problem, or entrapment of the nerves may have caused an internal injury.  A physician will perform a thorough examination in order to identify a cause.

In many cases, CRPS results from a variety of causes.  In such instances, treatments are directed at all of the contributing factors.

How is CRPS diagnosed?

Currently there is no specific test that can confirm CRPS. Its diagnosis is based on a person’s medical history, and signs and symptoms that match the definition.  Since other conditions can cause similar symptoms, careful examination is important.  As most people improve gradually over time, the diagnosis may be more difficult later in the course of the disorder.

Testing also may be used to help rule out other conditions, such as arthritis, Lyme disease, generalized muscle diseases, a clotted vein, or small fiber polyneuropathies, because these require different treatment.  The distinguishing feature of CRPS is that of an injury to the affected area.  Such individuals should be carefully assessed so that an alternative treatable disorder is not overlooked.

Magnetic resonance imaging or triple-phase bone scans may be requested to help confirm a diagnosis.  While CRPS is often associated with excess bone resorption, a process in which certain cells break down the bone and release calcium into the blood, this finding may be observed in other illnesses as well.

What is the prognosis?

The outcome of CRPS is highly variable.  Younger persons, children, and teenagers tend to have better outcomes.  While older people can have good outcomes, there are some individuals who experience severe pain and disability despite treatment.  Anecdotal evidence suggests early treatment, particularly rehabilitation, is helpful in limiting the disorder, a concept that has not yet been proven in clinical studies.  More research is needed to understand the causes of CRPS, how it progresses, and the role of early treatment.

How is CRPS treated?

The following therapies are often used:

Rehabilitation and physical therapy.  An exercise program to keep the painful limb or body part moving can improve blood flow and lessen the circulatory symptoms.  Additionally, exercise can help improve the affected limb’s flexibility, strength, and function.  Rehabilitating the affected limb also can help to prevent or reverse the secondary brain changes that are associated with chronic pain.  Occupational therapy can help the individual learn new ways to work and perform daily tasks.

Psychotherapy. CRPS and other painful and disabling conditions often are associated with profound psychological symptoms for affected individuals and their families.  People with CRPS may develop depression, anxiety, or post-traumatic stress disorder, all of which heighten the perception of pain and make rehabilitation efforts more difficult.  Treating these secondary conditions is important for helping people cope and recover from CRPS.

Medications. Several different classes of medication have been reported to be effective for CRPS, particularly when used early in the course of the disease.  However, no drug is approved by the U.S. Food and Drug Administration specifically for CRPS, and no single drug or combination of drugs is guaranteed to be effective in every person.  Drugs to treat CRPS include:

  • bisphosphonates, such as high dose alendronate or intravenous pamidronate
  • non-steroidal anti-inflammatory drugs to treat moderate pain, including over-the-counter aspirin, ibuprofen, and naproxen
  • corticosteroids that treat inflammation/swelling and edema, such as prednisolone and methylprednisolone (used mostly in the early stages of CRPS)
  • drugs initially developed to treat seizures or depression but now shown to be effective for neuropathic pain, such as gabapentin, pregabalin, amitriptyline, nortriptyline, and duloxetine
  • botulinum toxin injections
  • opioids such as oxycodone, morphine, hydrocodone, and fentanyl.  These drugs must be prescribed and monitored under close supervision of a physician, as these drugs may be addictive.
  • N-methyl-D-aspartate (NMDA) receptor antagonists such as dextromethorphan and ketamine, and
  • topical local anesthetic creams and patches such as lidocaine.

All drugs or combination of drugs can have various side effects such as drowsiness, dizziness, increased heartbeat, and impaired memory. Inform a healthcare professional of any changes once drug therapy begins.

Sympathetic nerve block. Some individuals report temporary pain relief from sympathetic nerve blocks, but there is no published evidence of long-term benefit.  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 that destroys some of the nerves is controversial.  Some experts think it is unwarranted and makes CRPS worse, whereas others report a favorable outcome.  Sympathectomy should be used only in individuals whose pain is dramatically relieved (although temporarily) by sympathetic nerve blocks.

Spinal cord stimulation.  Placing stimulating electrodes through a needle into the spine near the spinal cord provides a tingling sensation in the painful area.  Electrodes may be placed temporarily for a few days in order to assess whether stimulation is likely to be helpful.  Minor surgery is required to implant all the parts of the stimulator, battery, and electrodes under the skin on the torso.  Once implanted, the stimulator can be turned on and off, and adjusted using an external controller.  Approximately 25 percent of individuals develop equipment problems that may require additional surgeries.

Other types of neural stimulation. Neurostimulation can be delivered at other locations along the pain pathway, not only at the spinal cord.  These include near injured nerves (peripheral nerve stimulators), outside the membranes of the brain (motor cortex stimulation with dural electrodes), and within the parts of the brain that control pain (deep brain stimulation).  A recent option involves the use of magnetic currents applied externally to the brain (known as repetitive Transcranial Magnetic Stimulation, or rTMS).  A similar method that uses transcranial direct electrical stimulation is also being investigated.  These stimulation methods have the advantage of being non-invasive, with the disadvantage that repeated treatment sessions are needed.

Intrathecal drug pumps.  These devices pump pain-relieving medications directly into the fluid that bathes the spinal cord, typically opioids, local anesthetic agents, clonidine, and baclofen.  The advantage 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.  There are no studies that show benefit specifically for CRPS.

Emerging treatments for CRPS include:

  • Intravenous immunoglobulin (IVIG).  Researchers in Great Britain report low-dose IVIG reduced pain intensity in a small trial of 13 patients with CRPS for 6 to 30 months who did not respond well to other treatments.  Those who received IVIG had a greater decrease in pain scores than those receiving saline during the following 14 days after infusion.
  • Ketamine. Investigators are using low doses of ketamine—a strong anesthetic—given intravenously for several days to either reduce substantially or eliminate the chronic pain of CRPS.  In certain clinical settings, ketamine has been shown to be useful in treating pain that does not respond well to other treatments.
  • Graded Motor imagery.  Several studies have demonstrated the benefits of graded motor imagery therapy for CRPS pain.  Individuals do mental exercises including identifying left and right painful body parts while looking into a mirror and visualizing moving those painful body parts without actually moving them.

Several alternative therapies have been used to treat other painful conditions.  Options include behavior modification, acupuncture, relaxation techniques (such as biofeedback, progressive muscle relaxation, and guided motion therapy), and chiropractic treatment.

What research is currently being done on CRPS?

The mission of the National Institute of Neurological Disorders and Stroke (NINDS) is to seek fundamental knowledge about the brain and nervous system and to use that knowledge to reduce the burden of neurological disease.  The NINDS is part of the National Institutes of Health (NIH), the leading supporter of biomedical research in the world.

NINDS-supported scientists are studying new approaches to treat CRPS and to intervene more aggressively to limit the symptoms and disability associated with the syndrome.  Other NIH institutes also support research on CRPS and other painful conditions.

Previous research has shown that CRPS-related inflammation is caused by the body’s own immune response.  Researchers hope to better understand how CRPS develops by studying immune system activation and peripheral nerve signaling using an animal model of the disorder.  The animal model was developed to mimic certain CRPS-like features following fracture or limb surgery, by activating certain molecules involved in the immune system process.

Limb trauma, such as a fracture, followed by immobilization in a cast, is the most common cause of CRPS.  By studying an animal model, researchers hope to better understand the neuroinflammatory basis of CRPS in order to identify the relevant inflammatory signaling pathways that lead to the development of post-traumatic CRPS.  They also will examine inflammatory effects of cast immobilization and exercise on the development of pain behaviors and CRPS symptoms.

Peripheral nerve injury and subsequent regeneration often lead to a variety of sensory changes.  Researchers hope to identify specific cellular and molecular changes in sensory neurons following peripheral nerve injury to better understand the processes that underlie neuroplasticity (the brain’s ability to reorganize or form new nerve connections and pathways following injury or death of nerve cells).  Identifying these mechanisms could provide targets for new drug therapies that could improve recovery following regeneration.

Children and adolescents with CRPS generally have a better prognosis than adults, which may provide insights into mechanisms that can prevent chronic pain.  Scientists are studying children with CRPS given that their brains are more adaptable through a mechanism known as neuroplasticity.  Scientists hope to use these discoveries in order to develop more effective therapies for CRPS.

NINDS-funded scientists continue to investigate how inflammation and the release of adenosine triphosphate (ATP) may induce abnormal connections and signaling between sympathetic and sensory nerve cells in chronic pain conditions such as CRPS. (ATP is a molecule involved with energy production within cells that can also act as a neurotransmitter.  Neurotransmitters are chemicals used by nervous system cells to communicate with one another.)  A better understanding of changes in nerve connections following peripheral nerve injury may offer greater insight to pain and lead to new treatments.

Article Provided By: NIH

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