FAQ’s on Reflex Sympathetic Dystrophy (RSD) & Complex Regional Pain Syndrome Treatment in Las Vegas

Complex regional pain syndrome (CRPS) is a painful condition that results from damage to the nervous system. Also called reflex sympathetic dystrophy (RSD), this disorder usually affects an arm or a leg.

How common is complex regional pain syndrome?

According to statistics, the incidence rate of CRPS in the U.S. is 26 per 100,000 people. Women are affected slightly more often than men, and CRPS occurs most often in people ages 40 to 60 years of age.

What causes CRPS?

Complex regional pain syndrome occurs due to damage or injury to the sympathetic nervous system. The sympathetic nerves control blood vessels, temperature regulation, and sweating. Damage to these nerves leads to decreased blood flow, hypersensitivity, and temperature dysregulation.

What are the stages and symptoms of CRPS?

There are three main stages of complex regional pain syndrome, and symptoms follow a ‘usual’ pattern. The stages include:

  • Stage 1 (lasts 1-3 months) – Symptoms during this stage include muscle spasms, changes in skin temperature, burning pain, increased hair and nail growth, swelling, sweating, hypersensitivity, and skin color changes (blotchy, reddened, and/or purple).
  • Stage 2 (lasts 3-6 months) – Symptoms during this stage include slow hair growth, broken or cracked nails, worsening pain, stiff joints, and weakened muscles.
  • Stage 3 (occurs after 4-9 months) – After stages 1 and 2 are over, symptoms expected include muscle wasting, limited limb movement, contractures of muscles and tendons, and continued pain.

How does the doctor diagnose CRPS?

There is no one test used to diagnose CRPS. The diagnosis is based on medical history, physical examination, and pain complaints. To assess blood flow to the affected limb, special diagnostic tests are done. In addition, the doctor may order nerve conduction studies, x-rays, and bone scans.

How is complex regional pain syndrome treated?

There is no cure for CRPS. However, the condition is controllable, and patients do get better. The goal of therapy is to relieve symptoms and improve functional status. Treatment options include:

  • Medications – For nerve-related pain, the doctor may prescribe anticonvulsants, antidepressants, or a combination of these. Mild pain is treated with anti-inflammatory agents, and moderate-severe pain is treated with opioid analgesics.
  • Therapy – Occupational and physical therapy programs are began soon as the doctor makes the diagnosis of CRPS. The therapist works with the patient to keep joints and muscles moving, and to prevent worsening of the disease.
  • Stellate ganglion block – Using x-ray guidance for correct needle placement, the doctor will insert a small needle near the stellate ganglion nerves, which supply the upper extremities. An anesthetic agent is instilled onto the nerves to provide a blocking effect. A recent research study found this procedure to be 76% effective, with half of the participants reporting complete pain relief.
  • Intrathecal pain pump – This small device is surgically implanted near the spinal cord to deliver powerful pain medicine to the spinal fluid. Because the medication bypasses the gastrointestinal tract, the patient does not experience nausea, vomiting, or other unpleasant side effects.
  • Sympathectomy – The doctor can destroy a portion of the sympathetic nerve root using a neurolytic agent (phenol or alcohol) or radiofrequency energy. This is done using fluoroscopy (x-ray guidance). Based on a recent clinical study, this procedure was 77% effective for pain relief.
  • Spinal cord stimulation (SCS) – A spinal cord stimulator is a small surgically implanted device that is placed in the buttock or lower abdomen. Wires run from the device and connect to electrodes, which are surgically placed near the spinal cord. The device emits tiny electrical impulses that interfere with pain signal transmission. When used for CRPS, SCS has a 71% success rate.

Resources

Ackermann, WE & Zhang, JM (2004). Efficacy of stellate ganglion blockade for the management of type 1 complex regional pain syndrome. Southern Medical Journal, 1084-1088.

Bandyk, DF, Johnson, BL, Kirkpatrick, AF, Novotney, ML, et al. (2002). Surgical sympathectomy for reflex dystrophy syndromes. Journal of Vascular Surgery, 35(2), 269-277.

deMos M, De Bruijn AG, Huygen FJ, Dieleman JP, Stricker BH, & Sturkenboom MC (2007). The incidence of complex regional pain syndrome: a population-based study. Pain,129, 12–20.

Geurts, JW, Smits, H, Kemler MA, Brunner, F., Kessels, AGH, & van Kleef, M (2013). Spinal cord stimulation for complex regional pain syndrome type I: A prospective cohort study with long-term follow-up. Neuromodulation.