Your symptoms, feelings, and struggles have been dismissed for far too long!
Complex Regional Pain Syndrome (CRPS) is a neuropathic pain disorder characterized by ongoing debilitating pain that is disproportionate to the degree of tissue injury and persists beyond the usual expected time for tissue healing. Pain is accompanied by sensory, motor, and autonomic abnormalities. Pain does not follow a particular dermatome or myotome but is rather regional. This disabling condition often develops after a trauma, fracture, or surgery, but some spontaneous cases have also been reported.
In some cases, there is no precipitating event and there is no relation between severity of injury and development of this disorder. It was originally classified by the International Association for the Study of Pain (IASP) in 1994 and formally updated to the Budapest Criteria (2003), and now to the Valencia consensus (2019) due to its higher sensitivity and specificity; however CRPS remains a diagnosis of exclusion.
CRPS is further classified into: a) CRPS type I (previously Reflex Sympathetic Dystrophy) which typically develops after trauma or injury and does not involve a specific peripheral nerve; and b) CRPS type II (previously Causalgia) which develops after peripheral nerve injury. It can be further subdivided into “warm” (sympathetically maintained) or “cold” (sympathetically independent).
CRPS has two subtypes: type I, formerly known as reflex sympathetic dystrophy, and type II, formerly known as causalgia. Type I occurs in the absence of nerve trauma, while type II occurs in the setting of known nerve trauma. Clinically they are indistinguishable and follow a regional rather than a dermatomal or peripheral nerve distribution and favor the distal extremities, though spread outside of the initially affected area commonly occurs to the proximal or contralateral limb. CRPS is further subdivided into "warm" versus "cold," and sympathetically-maintained (SMP) versus sympathetically-independent (SIP), which may affect prognosis and treatment options. CRPS not only impacts function, sleep, and activities of daily living but also takes a significant mental and psychosocial toll on the patient. Its diverse spectrum of clinical presentation and lack of any clearly defined pathophysiology poses a challenge for optimal management of this disorder.
Previous Nomenclature: Reflex Sympathetic Dystrophy, Algodystrophy, Causalgia, Sudeck’s atrophy.
- Pain that's more severe than expected, and that can feel like burning or stinging
- Changes in skin temperature, color, texture, or sweating
- Swelling and stiffness in the affected joints
- Difficulty moving the affected body part
- Rapid hair or nail growth, or no growth
The most excruciating part - the pain is long-term and likely to be for life. CPRS is the world's most painful incurable condition. It's indiscriminately brutal nature has earned it the nickname "The Suicide Disease." The emotional toll patients experience can increase the likelihood of depression, anxiety, and suicidal ideation. As this disease takes pieces of the person you knew a loss of identity starts to take hold. With each new limitation, this is implemented deeper, keeping the cycle of grief constantly at play.
Awareness of complex regional pain syndrome (CRPS) by general practicing physicians is poor, which often leads to delays in treatment. Aggressive treatment should not be delayed as progressive worsening of symptoms is associated with poor prognosis. Rehabilitative therapies coupled with pharmacotherapy are the mainstays of early treatment. Interventional treatments are considered if conservative strategies fail. There are no well-accepted treatment guidelines for pharmacotherapy. The best evidence supports a multidisciplinary approach.
Treatment for CRPS can be difficult and frustrating. Each patient will be different, and an individualized approach is essential. Aggressive early treatment should be emphasized through an interdisciplinary approach. Most treatments are not well-documented in the evidence-based literature. Early physical and occupational therapy is important. Sympathetic blockade can be considered as the first interventional technique. Medication management to include corticosteroids and bisphosphonates are best supported in the literature. Other adjuvant medication can be considered, as previously described. Different pharmaceutic interventions can then be attempted to try to improve symptoms
- Physical Therapy and Occupational Therapy
- Mirror Box Therapy
- Graded Motor Imagery
- Tactile (Or Sensory) Discrimination Training
- Transcutaneous Nerve Stimulation (TENS)
- Cognitive Behavorial Therapies
- Complementary Therapies
- Hyperbaric Oxygen
- Electroconvulsive Therapy
- Antiepileptic Drugs Agents
- Nonsteroidal Anti-Inflammatory
- Bisphosphonates
- Calcitonin
- Corticosteroids
- Phenoxybenzamine
- Nifedipine
- Opioids
- Ketamine
- Antidepressants
- Disease Modifying Antirheumatic Drugs
- Free Radical Scavengers
- Topical Agents
- Intravenous immunoglobulin (IVIG)
- Therapeutic Plasma Exchange
- Sympathetic Block
- Intravenous Regional Blocks
- Spinal Cord Stimulation
- Dorsal Root Ganglion Stimulation
- Implantable Intrathecal Continuous Infusion Pump
- Intrathecal Baclofen Therapy
- Amputation
- Surgical Sympathectomy
- Motor Cortex Stimulation
- Deep Brain Stimulation
Vitamin C has been studied as a prophylactic treatment for CRPS that acts by inhibiting pro-inflammatory pathways mediated through antioxidant mechanisms. There have been mixed results in its effectiveness. A 2022 review found that vitamin C administration reduced the rate of CRPS-1 after distal radius, wrist, foot, and ankle surgeries, with an odds ratio of 0.33 compared to placebo.32 However, because it is a low risk intervention physicians may consider it as a prevention strategy.1 Daily supplementation with 500 mg of vitamin C per day for 50 days may be beneficial to decrease risk of developing CRPS-I after distal radial fracture, foot and ankle surgery or trauma.
Prognosis is best with early diagnosis and treatment. Once delayed, CRPS can spread proximally in the affected limb and to other areas of the body. Significant loss of function, atrophy, and contractures can result. Non-organic factors may worsen CRPS. As such, psychological therapy can be an important component and may include cognitive behavioral therapy.
There is controversy over the accepted pathophysiology of the disorder. Initially, CRPS was thought to be predominantly mediated through the sympathetic nervous system; however, autonomic symptoms are often not seen in clinical presentation. Moreover, some CRPS patients do not get relief from sympathetic blockade and plasma catecholamine levels are generally lower in the affected limb.
Other mechanisms thought to be involved include cortical reorganization, exaggerated inflammatory response, and neurogenic inflammation primarily through neuropeptide mediators including bradykinin, calcitonin gene-related peptide, and substance P.
A major gap in the evidence is the paucity of double-blinded placebo-controlled clinical trials. For a variety of reasons, CRPS patients are commonly excluded from pharmaceutical studies. There are no absolute specific or generalized guidelines for management of CRPS, nonetheless the treatment must be tailored according to each type of patient based on chronicity and presenting symptomatology. There is not enough evidence to fully support any of the proposed treatment approaches. Some of the factors mentioned include the limitation to find an adequate sample for randomized controlled trials, leaving us with a lack of powerful enough studies to establish standardized management.
I've been living with Complex Regional Pain Syndrome since 2011, the same year my life changed forever the day before my 33rd birthday. When I left for work that day, I had no idea the man that I had been all my life, the man I had worked my hands to the bone to become, would never walk through that door again.
It took me 3 years and countless medical professionals that either dismissed me or treated me like their guinea pig to get diagnosed. During this time, I watched everything fade away. I watched pieces of myself disappear, only to be replaced with my illness. I watched my friends fall off one by one. I watched my ex-wife fall out of love with me as I became nothing but a burden she did not want understand. I watched my children become farther and farther away from me when I could no longer do the things I used to for and with them. My ex-wife sided with doctors against me, my sons still do not know what CRPS is, my mother would act sympathetic while the nature of my illness went in one ear and out the other, and friends stopped calling. I suddenly I realized how alone I was and how wrong I had been about the people I called friends, and that I called family. People that claimed loyalty, disappeared.
The darkest corners of my mind were my home, they were the only place I felt I belonged. I became consumed by the dark abyss I had created to protect me and I had given up. I again reached the point of no return and this world would not have to suffer my existence much longer.
At this darkest hour, of my life someone reached out. Someone cared. That's the only reason I'm still breathing. Most days I still want to quit. Things don't get better. I don't feel better. I'm still invisible. It's indescribable to walk through life while losing time and not knowing who you are.
I started as a caregiver for my boyfriend who suffers from CRPS that has spread throughout his body. A year and 3 months in, I went from advocate, supporter, and caregiver to diagnosed CRPS patient.
Living with neurodiversity and severe mental illness has been a lifelong journey for me. A day without pain is not something I have ever known. Having multiple illnesses that involve having extremely painful hypersensitivities, both mentally and physically, to things people can't understand or even fathom costs you relatability. When people can no longer relate to you, they no longer what to be a part of your life. The barrier has always been there for me. Isolation forces you to sit in a dark place where feelings of not being enough and never doing anything right become the narrative you believe and tell yourself. A place so dark no one can see you and you feel unworthy of love.
The day I got diagnosed with CRPS was the day I realized I would always exhausted, I would always be on fire, and I would always reach a point where I would want it all to just end. My level of self-control has to be at max power 24/7. I am constantly navigating my pre-existing 3rd degree emotional burns in the form of ultra rapid cycling, disassociation, and fear of the unknown. My physical pain is masked by my intolerable emotional pain. The isolating nature of the beast are the extreme symptoms. You come off as "too much" or "not enough" - there's no gray of understanding. When others can't comprehend the level of pain you feel, it's hard to have compassion. Choosing quality over quantity can make us look selfish and full of excuses - but the simple reality is - having limited tolerance, functionality, and high pain means I have to wisely choose where I put what little energy I do have.
While this has been very defeating at times, I try to stay positive. My goal is to let others know that they aren't alone in what they are facing. Feeling alone while in a scary situation can be a traumatic experience, I aim to give more people a place to turn when they feel that have no where to go.
I have a whole new respect for this monster. I developed CRPS after a meniscus repair gone bad and 3 surgeries later believe it has spread. I’m on a mission to get better and feel like I’m truly fighting for my life and limbs.
Learning to mourn the old life I was able to live. The online support groups have helped me the most and I cling to others for support and knowledge of the steps they took to get into remission.
On days I wanna give up I rest. Other days I wanna give up and get up and put up more of a fight and then rest. Exercise and movement is my friend. The PT where I run a cotton ball and work up to a loofa is very slowly getting a bit better.
I make gratitude lists and hold tight for better days. It’s not easy but I know it’s in me and I’m gonna fight! 🧡🔥🧡
I am a 40 y/o CRPS Warrior, wife, and mama of two amazingly wild 8 y/o twin boys. I am sharing the following, first, to give a brief description on my medical training and knowledge in the medical field and healthcare system prior to my CRPS diagnosis.
I started taking healthcare courses from 1998 to 2001. I became a CNA at 17. Later, I attained my Asoociates Degree in Science of Nursing - RN in 2009. I worked in all settings; specializing in ER, Pediatrics, & Pediatric ER medicine.
Fast forward from 2020 to present day. A dimensional shift is pretty much the only way I can describe the Healthcare system today. A very sad, dysfunctional, broken, and indoctrinated medical system that has let down, mistreated, ignored, and gaslit patients. This is due to medicine and (Big Pharma) not treating patients the way they should be treated, and our tried and trusted insurance system that is in bed with the docs, and Big P. We are no longer taken seriously. Doctors no longer try to get to the root of the problem. They no longer care, as they just prescribe medications, get perks from big pharma, and then keep patients sick from the medications they prescribe. Which causes the need for more medications to treat all of the side effects these toxic drugs cause.
I was diagnosed with CRPS 8 months after an "outpatient, routine, exploratory abdominal surgery" in Jan 2020, for possible endometriosis. My life, my world blew up as I knew it. If the young, surgery hungry doc that performed my surgery would have looked at my MRI scans, he would have seen that I had adenomyosis and could have concluded that my symptoms were due to that vs causing CRPS for an exploratory surgery for endometriosis.
There is more back story to having CRPS, years prior from other surgeries, but it went undiagnosed. I can leave out those details because, the point is, I was diagnosed with CRPS. The way I was diagnosed, was a heartless, uncompassionate doctors visit. I was trying to figure out all the 'whys'. Why I was in excruciating pain, why I could not walk and function as I once did, why I could not care for my kids and family, why I was exhausted beyond recognition, why I could not eat, sleep, think. Why I could no longer be the active, vivacious women I once was. A gym rat, a mom that could pick up and hold her babies. Why I was having to explain to my almost 2 year old boys (when CRPS actually started but kept getting dismissed by the doctors). Why mommy couldn't pick them up anymore, or pick them up to nurse them and daddy had to help. Why was this happening? Why does each doctor I see that is clueless - just keep referring me from one doctor to the next? (Big P and getting insurance to pay for all of these "I dunno, go here" visits. My doctor, a neurologist that I worked with, handed me a business card with CRPS written on the back of it, and he told me to Google it, maybe follow up with pain medicine, and gave me a horrible prescription for nerve pain medications along with steroids that causes more crippling & debilitating side effects than are worth taking.
The ironic thing is, we, healthcare personnel, are all too familiar with patients that Google symptoms. We tell them to never Google their symptoms. Yet, this doctor could not take a moment to sit with me and explain this horrific, life altering disease to me. He handed me a business card and walked out. I was bawling in pain, fear, confusion and devastation.
I got to a very dark place. As most warriors are in, or get to. I will never forget that first year. Being bed/couch bound. Screaming in pain into the couch cushions/pillows when I was at my whits end. I remember blacking out at multiple times. This one time in particular, my boys ran up to the couch, my husband was asleep in the recliner behind me. I was literally screaming into the back of the couch cushions. My, then, 4 y/o sons were so concerned. During my screams, I remember thinking, what the hell am I putting these poor boys through. I screamed one last time after contemplating that they would be better off without me. I had to make a change, on my own, without the doctors. I pushed myself up off the couch and said, no more. I WIĹL be here for my family, regardless of whether I need to take a lot of breaks, or be in a wheelchair, or limit/cancel activities. The old me is gone and I had to let go of her. It didn't mean that the new, altered me couldn't have a life as well.
Even though I have a medical education, CRPS was never taught in any of my schooling. After being diagnosed, I learned very quickly that it is not taught in medical school either. It is almost impossible to find a doctor that has taken a course, or specialized training in CRPS. Which makes this condition one of the worst, most dangerous diseases out there, as patients go for far too long without a diagnosis, without proper early treatment, with dismissed symptoms, medical gaslighting, inappropriate medication prescriptions just to 'appease' the steps they have to take to say they 'addressed the patients pain/symptoms' to the medical system, government or higher ups that control all of that. It is insane, barbaric, and inhumane how the medical system has failed CRPS Warriors! And, a lot more patients with other diagnosis' as well.
When I say it is dangerous, I will clarify by saying, CRPS is nicknamed the "suicide disease". By medical professionals lacking the education to properly diagnose patients early on, or at anytime; it is extremely dangerous. It can cause the patients to not get early access to treatment that may help put them in remission, only if caught and treated early. It can cause a patient to get so frustrated, and despaired with the doctors referring them from one doctor to the next, waiting for pre-authoritions, or approvals to see one doctor to the next, or wait for testing, or scans. Waiting for insurance pre-authorizations for the next doctor. Only to try and schedule an appt to find that they are months booked out. It is an ongoing, vicious cycle that haunts warriors.
Warriors are already in the battle of their life with this complex condition, let alone trying to navigate the doctors and Healthcare system game. We often get so discouraged with no signs of help, relief, or end in sight. We break. We physically and mentally cannot handle all of this. And god forbid a warrior is on their own with no support system. Many warriors, end their own life as it is just too much. Too much pain, too much to handle with all that the doctors, insurance, and broken medical system puts them through. This is never ok or acceptable.
Final words of advise from a healthcare worker and CRPS warrior: please educated yourselves, and other doctors. Take courses in CRPS, treatment options and pain management. Have compassion with patients presenting with unrelenting pain that is out of proportion from the original injury. Help patients with treatment options that are out of the usual prescribing medications and referring out. Be the doctor that helps us, not hurts us.
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