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Complex regional pain
syndrome, reflex sympathetic dystrophy, RSD, Causalgia,
Shoulder-hand syndrome, or Sudeck's
atrophy.
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Complex
regional pain syndrome (CRPS) is a chronic pain syndrome,
usually involving one leg or
arm.
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The
symptoms vary in severity and duration. The pain is usually
localized to the injured arms or legs, but CRPS can affect
any part of the body.
- The main symptoms are a throbbing, burning pain coupled with a tingling sensation. This severe pain is often accompanied by extreme sensitivity to even the slightest touch in the affected areas of skin.
- The symptoms of the acute stages (first 3 to 6 months) are characterized by swelling, tenderness, excessive sweating, heating sensation and a change in skin color (reddish, mottled) in the affected area. After an acute period, the skin becomes cool and bluish in some patients.
- Other changes include a thickening
of the skin tissue or a swelling and heating sensation. In
later periods where there is joint stiffness coupled with
contracture and a thinning of the skin, subcutaneous and
muscle tissue can be seen. However, the course of disease is
different from person to
person.
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The mechanism of pain is uncertain. CRPS develops after a wide variety of tissue injuries, including bone fractures, soft tissue trauma and Strokes. CRPS can also occur after minor injuries.
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The diagnosis is based on the history of the injury, symptoms and signs.
- Radiologic tests are supportive.
- Simple X-Rays of affected area to detect the bone loss (osteoporosis) in the later stages.
- Bone
scans
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- There is no single treatment that cures CRPS.
- The response of patients to therapy may vary
- Corticosteroid (prednisone) -- short-term therapy with prednisone may result in the early remission of CRPS in some patients.
- Drugs for pain control -- various drugs are used to relieve pain from CRPS, including anti-seizure medications, antidepressants and opioids.
- Physical therapy relieves swelling and prevents contracture.
- Sympathetic nerve blocks -- injection of local anesthetics to the sympathetic nerves in the neck (stellate ganglion) or lower back (lumbar sympathetic nerve blocks).
- Lumbar sympathectomy -- destruction
of sympathetic nerves to get longer pain relief than the
nerve block.
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- Early treatment is most effective if started within 3 months from the onset.
- About 50 to 60 % of CRPS patients have significant chronic pain for
6 months.
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