An ankle sprain or broken wrist is uncomfortable and inconvenient, but with proper treatment you can recover completely.<\/p>\n
But for some people, even small traumas can lead to a severe and debilitating pain disorder called complex regional pain syndrome (CRPS). The exact cause is unclear, but research suggests it may result from nerve damage after an injury.<\/p>\n
It feels like an intense throbbing or burning. Instead of getting better as days go by, the pain grows.<\/p>\n
\u201cPain neurons [at the site of an injury] are only supposed to fire briefly to signal a problem,\u201d says Anne Louise Oaklander, M.D., Ph.D., director of the Nerve Injury Unit at Massachusetts General Hospital in Boston. \u201cBut in CRPS, these neurons get short-circuited, causing them to fire continually \u2013 resulting in prolonged, debilitating pain.\u201d<\/p>\n
CRPS affects as many as 1.2 million Americans, and up to 75% are women, according to the Reflex Sympathetic Dystrophy Syndrome Association, a nonprofit that aims to help educate sufferers, insurance companies and health-care providers. (Reflex Sympathetic Dystrophy Syndrome is another name for CRPS.)<\/p>\n
A Mysterious Condition
Because the pain often seems out of balance with the level of harm initially suffered, many patients\u2019 concerns are dismissed.<\/p>\n
\u201cA doctor sees someone in agony over a sprained ankle, and it seems so exaggerated and out of proportion to the injury that they have a difficult time believing the pain is real,\u201d explains chronic pain specialist Robert Schwartzman, M.D., chairman of the neurology department at Drexel University College of Medicine in Philadelphia.<\/p>\n
In 2006, Oaklander and other Massachusetts General researchers discovered key evidence of a physical abnormality linked to CRPS.<\/p>\n
\u201cThe skin in the affected area appears to have lost some small nerve-fiber endings,\u201d Oaklander says. \u201cThese nerve endings transmit pain messages, control skin color and temperature, and may be involved in other pain disorders \u2013 so we believe they may also be linked to CRPS.\u201d<\/p>\n
Other research suggests an immune response following the injury may irritate pain neurons, causing them to fire, adds Schwartzman. That may help explain the fact that more women have the disorder.<\/p>\n
\u201cWe aren\u2019t exactly sure why, but women are more susceptible to autoimmune problems,\u201d he says.<\/p>\n
Another group at risk for the pain disorder: People with broken bones. Having your arm or leg in a cast following a fracture inhibits movement, which can further reduce blood flow and worsen damaged nerves. So you should see a doctor immediately if swelling and inflammation worsen within the first few days of getting the cast, advises Oaklander.<\/p>\n
In rare cases, even donating blood can put you at risk for CRPS.<\/p>\n
\u201cThere are two sensory nerves that wrap around the vein where blood is drawn,\u201d says Oaklander. \u201cIf this nerve is accidently pricked or injured during blood donation, you can wind up with symptoms of CRPS.\u201d<\/p>\n
Fortunately, these cases are very mild and can be easily treated, so consult your doctor if you notice discomfort following blood donation.<\/p>\n
Decoding the Symptoms
Besides an intense throbbing pain that gets worse instead of better , the affected area in CRPS may also be extremely sensitive to touch and subject to drastic changes in temperature and color.<\/p>\n
\u201cOverstimulated pain nerves change how blood vessels react,\u201d Schwartzman says. \u201cAs they dilate, it causes the area to turn hot, red and swollen. And then they constrict, leaving the area cold and blue.”<\/p>\n
These damaged nerves are also connected to your sweat glands, bones and muscles, so their misfiring results in excessive sweating, muscle spasms, joint stiffness and decreased mobility, Schwartzman says.<\/p>\n
While pain may begin at the point of injury, in some cases it spreads.<\/p>\n
\u201cSome people find the pain that started in their right foot will suddenly appear in their left foot,\u201d Schwartzman says. \u201cWe believe this may be caused by a reorganization of nerves and neurotransmitters caused by the trauma.\u201d<\/p>\n
\u201cLeft untreated, complex regional pain syndrome will continue to get worse, and joints and muscles may begin to weaken and atrophy,\u201d says pain-management specialist Charles Argoff, M.D., a neurologist at the Albany Medical Center in New York.<\/p>\n
Changing the way you stand, walk or hold yourself in an attempt to alleviate pain in the affected limb can also lead to back, neck and shoulder problems, Argoff says.<\/p>\n
\u201cSymptoms vary from person to person, but the sooner you receive treatment, the more effective it will be,\u201d he says.<\/p>\n
Getting a Diagnosis
Identifying the problem can be extremely difficult if your doctor doesn\u2019t know what to look for.<\/p>\n
That\u2019s especially true of what\u2019s called type 2 CRPS. While type 1 is caused by an injury you can see, type 2 results from nerve damage whose origins may be unclear.<\/p>\n
\u201cWomen are often misdiagnosed with fibromyalgia, another chronic syndrome characterized by bodywide pain,\u201d Schwartzman says. \u201cAnd doctors unfamiliar with complex regional pain syndrome still assume patients are embellishing their symptoms, so it\u2019s important to be persistent until you get the care you need.\u201d<\/p>\n
Unfortunately, there\u2019s no single test to determine whether you have CRPS. Neurologists and peripheral nerve specialists are best trained to make the diagnosis.<\/p>\n
\u201cThey\u2019ll conduct a clinical exam to measure skin temperature, sweat, skin sensitivity and circulation in affected limbs, which can all [show] signs of the condition,\u201d Oaklander explains.<\/p>\n
\u201cBone scans and X-rays may also be used, as CRPS can reduce blood flow and cause loss of bone minerals and other changes in bone cartilage,\u201d Schwartzman says. \u201cAnd an MRI can also reveal tissue damage that signals CRPS.\u201d<\/p>\n
Getting Treatment
While there\u2019s no cure for complex regional pain syndrome, early treatment can slow progression of the condition and, for many people, lead to a state of remission.<\/p>\n
The first rule is to stay active, even if your natural instinct is to give your body a break.<\/p>\n
\u201cIf you don\u2019t use it, you lose it,\u201d Argoff says. \u201cEarly movement and physical therapy are crucial to restoring circulation and mobility in the affected area. If you remain stationary and don\u2019t get your blood pumping, the swelling may worsen and muscles may begin to deteriorate.\u201d<\/p>\n
What\u2019s more, brain-imaging tests suggest that if you stop using the limb, the synapses that send its messages to the brain will wither from lack of use and be taken over by signals from more active parts of your body \u2013 making it even more difficult to recover normal movement, says Oaklander.<\/p>\n
Pain medications are often prescribed to help patients get the exercise needed for rehabilitation. Corticosteroids are used to ease inflammation, blood pressure medications may be used to improve circulation, and medications such as Fosamax and Miacalcin can help stave off bone loss.<\/p>\n
Unfortunately, the condition can have profound psychological effects, and depression and anxiety can heighten the perception of pain. As a result, antidepressants are sometimes used with other remedies to improve quality of life, says Schwartzman.<\/p>\n
Injecting Botox into the affected area can reduce pain by almost a third, according to a 2011 study by Schwartzman and colleagues at Drexel University. The toxin helps paralyze pain nerves, preventing them from firing and helping muscles relax.<\/p>\n
Research also suggests that spinal cord stimulation may be successful at treating complex regional pain syndrome.<\/p>\n
\u201cElectrodes give off a tingling sensation in the painful area [that replaces the feeling of pain],\u201d Argoff says. \u201cThey\u2019ve improved pain control for many patients.\u201d<\/p>\n
Another promising treatment are sympathetic nerve blocks \u2013 anesthetics administered intravenously to turn off pain receptors, or placed next to the spine to block sympathetic nerves (which mobilize the body\u2019s stress response).<\/p>\n
\u201cWithin two days of treatment, patients should expect to feel an improvement,\u201d Schwartzman says. \u201cThe response is variable, but if it\u2019s successful, it usually lasts for three months. And occasionally, if the patient is treated early, they won\u2019t need any additional rounds of treatment.\u201d<\/p>\n
For some patients with an unknown trauma, surgery may be the best option.<\/p>\n
\u201cYou may have tiny tumors, vascular malformations or entrapment of a nerve, which can be corrected during nerve surgery,\u201d Oaklander says.<\/p>\n
\u201cUnfortunately, there\u2019s no one-size-fits-all remedy,\u201d Argoff says. \u201cA combination that works for one patient may not work for another.\u201d<\/p>\n
Identifying the problem can be extremely difficult if your doctor doesn\u2019t know what to look for.<\/p>\n
That\u2019s especially true of what\u2019s called type 2 CRPS. While type 1 is caused by an injury you can see, type 2 results from nerve damage whose origins may be unclear.<\/p>\n
Some simple lifestyle changes appear to also increase your chances of recovery.<\/p>\n
\u201cOne of the most common barriers I see in healing is smoking,\u201d Oaklander says. \u201cCigarettes constrict your blood vessels, which means the affected area isn\u2019t getting the oxygen it needs to repair the damage. I\u2019ve seen smoking cessation alone help cure people with complex regional pain syndrome.”<\/p>\n
Diabetes can also impair blood flow and prevent damaged nerves from healing, so monitoring your diabetes with help from your doctor, and maintaining a healthy weight through diet and exercise, may also speed recovery, suggests Oaklander.<\/p>\n
Whatever your recommended treatment, the first step toward healing is speaking up, Oaklander says.<\/p>\n
\u201cThis pain is real and you don\u2019t have to live with it,\u201d he insists. \u201cPatients should expect to recover, but you can\u2019t get better if you don\u2019t get help.\u201d<\/p>\n<\/div>\n<\/p>\n
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