Complex Regional Pain Syndrome (CRPS) / RSD is a chronic pain condition that most commonly occurs after injury to a limb from surgery or trauma. The symptoms regionalize, meaning they spread beyond the area of direct injury. As suggested by its name, the symptoms and causes of CRPS are complex. Symptoms vary from patient to patient, but they may include any of the following: severe pain and hypersensitivity, hyperhidrosis (increased sweating) in the limb, edema (swelling), color changes, temperature changes, nail changes, and skin changes. One common feature of CRPS is allodynia, or pain elicited by non-noxious stimuli such as wind blowing over the skin.
CRPS is thought to occur as the result of a malfunctioning central nervous system (brain and spinal cord) and peripheral nervous system (nerves in the arms and legs). Tissue abnormalities such as inflammation and abnormal blood flow are also involved. Treatments are aimed at restoring normal function through a multimodal approach including physical therapy, injections, medication, psychotherapy, and neuromodulation.
The pain intensity in CRPS is among the most severe of any pain condition. Early diagnosis and treatment is essential in order to prevent progression to the chronic stages of the disease. In the more chronic condition, the symptoms can spread to other regions of the body.
Our Office Provides Treatment with the Following:
- Stellate Ganglion Blocks
- Lumbar Sympathetic Blocks
- Epidural Injections
- Selective Nerve Root Injections
- Ketamine Infusions
- Lidocaine Infusions
- Spinal Cord Stimulation
- Intrathecal Drug Delivery/ Spinal Medication Infusions
- Nerve Blocks
Neuromodulation for CRPS:
The nervous system includes the brain, spinal cord, and peripheral nerves. These structures communicate by using a complicated system of chemical and electrical properties. In CRPS, the complicated circuitry of the nervous system works incorrectly. Pain management techniques aim at altering the activity of the nervous system in order to diminish pain.
More specifically, neuromodulation is technology that alters nerve activity by delivering electrical or pharmaceutical agents directly to the target area. Multiple studies have proven the effectiveness of neuromodulation for the treatment of pain from CRPS.
Electricity is applied to the spinal cord with an implanted device called a spinal cord stimulator. Pharmaceutical agents are applied to the spinal cord with an implanted device called an intrathecal drug delivery system. Prior to any type of surgical implant, patients have the opportunity to undergo a temporary trial to confirm that the technology provides substantial relief.
Medication Infusions for CRPS: (See Blog)
A growing body of evidence has proven the effectiveness of certain intravenous infusions for the treatment of CRPS. These medication have been used by anesthesiologists for many decades to treat surgical pain. More recently, the literature has suggested a role for these medications in the treatment of certain chronic pain conditions such as CRPS. Specifically, ketamine is a medication referred to as a dissociative anesthetic, which can be extremely effective in treating CRPS when given as an intravenous infusion. Lidocaine is a second agent used for the treatment of pain in CRPS. Lidocaine is a local anesthetic with properties similar to novicaine.