Know These Warning Signs of Complex Regional Pain Syndrome

5 treatments for worsening pain after an injury

Coping with pain from an injury or surgery is difficult enough when it first happens. But if you continue to feel pain — and the pain gets worse — after you’ve had time to heal, you may have complex regional pain syndrome (CRPS). And you’ll need help to cope with it.

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So, if the pain from your initial injury lingers longer than your doctor told you to expect, let him or her know right away.

Identifying the condition as quickly as possible can make it easier to manage discomfort and maintain your long-term quality of life, says pain management specialist Hersimren Basi, MD.

“With CRPS, you really need to push for early diagnosis and early treatment,” she says. “It makes intervention easier and more effective. You don’t want to lose range of motion of a limb.”

The good news is that there are effective techniques to help manage your pain, Dr. Basi says.

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When should you suspect CRPS?

CRPS is a progressive disease that attacks the nervous system and causes pain following an injury, fracture or surgery. It typically affects arms or legs, but can show up in any part of the body.

The pain is usually stronger than what occurs with the original injury, Dr. Basi says. Identifying the condition is difficult because doctors must rule out other conditions first, she says.

If you have CRPS, you may notice these signs:

  • Extreme sensitivity to touch and temperature
  • Pinprick sensations
  • Different temperatures throughout the body
  • Skin color changes
  • Swelling
  • Excessive sweating
  • Decreased range of motion
  • Muscle weakness
  • Hair, skin and nail changes

What symptoms best characterize CRPS?

There are many symptoms doctors associate with CRPS.  Here are some:

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  • Increased sensitivity. The painful area may become extremely sensitive, even to the lightest touch. Cold air can even aggravate it.
  • Inflammation or skin changes. The skin around the area can appear bruised, shiny and/or purplish.
  • Swelling. The affected limb can become swollen intermittently, or stay swollen.
  • Loss of function. You may notice a decreased ability to move that limb or increased stiffness. Those with CRPS may also have difficulty placing any pressure on that particular joint or limb.

5 treatments to manage CRPS

The best option for managing or relieving CRPS pain is physical therapy, Dr. Basi says.

  1. Desensitization. This therapy stimulates the brain using different textures, temperatures and pressures over short periods of time. Over time, your brain adjusts to the sensations, and your pain gradually decreases.
  2. Mirror therapy. A therapist uses your reflection to trick the wounded limb into thinking it is moving without pain. You will put your injured arm or leg inside a box with a mirror on it. The mirror reflects your uninjured limb as it claps or makes other rhythmic motions. Your brain perceives it as your injured limb, and this helps your symptoms decrease over time.
  3. Nerve pain medications. Although there are no FDA-approved drugs to control pain from CRPS, Dr. Basi recommends nerve pain or neuropathic pain medications as an important part of the treatment plan as they may be very helpful in reducing pain associated with CRPS.
  4. Nerve block. This injection can interrupt the pain signal and decrease the discomfort you feel. You may  require more than one injection.
  5. Nerve stimulation. For the severe or refractory CRPS cases, doctors may attempt to block your pain by using electrical impulses near the spinal cord or dorsal root ganglion (DRG). DRG stimulation is a more targeted therapy that concentrates stimulation where doctors suspect the pain originates.

A physical therapist will typically use desensitization and mirror therapy as two unique approaches specifically for CRPS.

Ultimately, Dr. Basi says, patient relief is what’s most important. “The goal with chronic pain, in general, is to help the patient become more functional,” she says. “And, we can do this by keeping them out of pain.”

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