Complex Regional Pain Syndrome
Complex regional pain syndrome (CRPS) is a neurological disease characterized by prolonged pain and inflammation that usually affects an arm or a leg and typically develops after an injury, a surgery, a stroke or a heart attack. The pain experienced by the person is out of proportion to the severity of the initial injury.
There are 2 types of CRPS:
- Type I: This type occurs after an illness or injury that didn't directly damage the nerves in the affected limb. About 90% of people with CRPS have type 1
- Type II: This type occurs after a distinct nerve injury
What is the Etiopathogenesis of CRPS?
Signs and Symptoms:
- Continuous burning or throbbing pain, usually in the arm, leg, hand or foot
- Sensitivity to touch or cold
- Swelling of the painful area
- Changes in skin temperature — alternating between sweaty and cold
- Changes in skin color, ranging from white and blotchy to red or blue
- Changes in skin texture, which may become tender, thin or shiny in the affected area
- Changes in hair and nail growth
- Joint stiffness, swelling and damage
- Muscle spasms, tremors, weakness and loss (atrophy)
- Decreased ability to move the affected body part
JEEVISHA protocol for management of Complex regional pain syndrome:
Most of the cases of CRPS resolve spontaneously as the injured nerve heals. However, treatment of CRPS is most effective if started early.
- Physical therapy: Physiotherapy plays a very important role in the management of CRPS by improving the local tissue circulation and maintaining the flexibility and function of the painful limb. Starting the patients on some mental exercises helps reversing the secondary changes in the brain that prolong CRPS.
- Medications and other conservative treatment options: Patients are generally started on Neuropathic medications. Doses are slowly titrated to get the adequate pain relief with minimum side effects.
However, if used alone, most of patients develop tolerance or side-effects to the prescribed medications.
Thus, at our centre we use Multiple modalities which when combined prevent early development of side effects of the medications. These include
- Perineural and intramuscular Dry needling in the area of distribution of the particular branch involved
- Botox injections which not only reduce the muscle spams associated with this condition but also produce neuromodulation and subsequent reduction in disease symptoms.
- Intravenous ketamine infusion therapy
- Alternate strategies: Psychotherapy, Relaxation techniques and behaviour modifications
Targeted MIPSI Interventions:
- Fluoroscopy guided Lumbar sympathetic block/ Chemical neurolysis, Radiofrequency ablation
- Intrathecal drug delivery systems
- Spinal cord stimulators