Complex Regional Pain Syndrome

Diagnosis

Although there is no single test that can accurately diagnose CRPS, a diagnosis is typically made based on medical history and physical examination results. However, the following procedures may provide important information:

• Bone scan. Finding bone changes could be aided by this procedure. Your bones can be observed with a special camera after having a radioactive material injected into one of your veins.
• Sweat production tests. The amount of sweat on both limbs can be measured by certain techniques. Uneven outcomes could be a sign of CRPS.
• X-rays. Later stages of the disease may cause mineral loss from your bones, which will be visible on an X-ray.
• Magnetic Resonance Imaging (MRI). An MRI test’s images may reveal tissue changes that rule out other illnesses.

Treatment

Some data suggests that CRPS symptoms may be improved with early treatment. Frequently, a mix of many therapies adapted to your unique situation is required. Options for treatment include:

Medications

To treat CRPS symptoms, doctors use a variety of drugs.

• Pain relievers. Aspirin, ibuprofen, and naproxen sodium, which are accessible over-the-counter painkillers, may reduce minor pain and inflammation.

If over-the-counter medications are ineffective, your doctor may recommend harsher painkillers. Drugs that include opioids may be a possibility. They might aid in pain management when used sparingly.

• Antidepressants and anticonvulsants. When a damaged nerve causes pain (neuropathic pain), antidepressants like amitriptyline and anticonvulsants like gabapentin may be used to treat it.
• Corticosteroids. Prednisone and other steroids may lessen inflammation and increase mobility in the injured limb.
• Bone-loss medications. Your provider may suggest medications to prevent or stall bone loss, such as alendronate and calcitonin.
• Sympathetic nerve-blocking medication. Some persons may have pain relief after an injection of an anesthetic to block pain fibers in the afflicted nerves.
• Intravenous ketamine. Studies suggest that even small amounts of the potent anesthetic ketamine intravenously can significantly reduce pain.
• Medicines to lower blood pressure. Pain management may occasionally be assisted by high blood pressure drugs such as clonidine, phenoxybenzamine, and prazosin, among others.

Therapies

• Topical pain relievers. There are several topical medications that can lessen hypersensitivity, such patches or creams containing lidocaine or the over-the-counter capsaicin cream.
• Heat therapy. On skin that feels chilly, applying heat may provide relief from discomfort and swelling.
• Mirror therapy. A mirror is used in this kind of therapy to deceive the brain. You move the healthy limb while seated in front of a mirror or mirror box so that the brain sees it as the CRPS-affected limb. According to research, this kind of therapy may benefit CRPS patients by enhancing function and lowering pain levels.
• Physical or occupational therapy. Pain may be reduced and range of motion and strength may be increased with gentle, supervised exercise of the afflicted limbs or with modification of regular activities. Exercises may be more beneficial depending on how soon the condition is identified.
• Transcutaneous Electrical Nerve Stimulation (TENS). Electrical impulses can sometimes be applied to nerve endings to reduce chronic pain.
• Biofeedback. Learning biofeedback skills may be helpful in some situations. You may relax your body and get rid of pain by using biofeedback, which teaches you to become more conscious of your body.
• Spinal cord stimulation. This technique involves the insertion of small electrodes along the spinal cord by a healthcare provider. The application of a low-level electrical current to the spinal cord can help reduce pain.
• Intrathecal drug pumps. Painkillers are injected directly into the spinal fluid in this treatment.
• Acupuncture. Long, thin needles inserted into the body may stimulate the nerves, muscles, and connective tissue to improve blood flow and reduce pain.

Recurrences of CRPS can occur, sometimes triggered by factors such as exposure to cold or significant emotional stress. To address these recurrences, a low dose of an antidepressant or other medication may be used.