Complex Regional Pain Syndrome/ Reflex Sympathetic Dystrophy
Complex regional pain syndrome (CRPS), formerly reflex sympathetic dystrophy or causalgia, is a chronic progressive systemic disease characterized by severe pain, swelling, and changes in the skin. It often affects an arm or a leg and can spread throughout the body. Recent evidence has led to the conclusion that Complex Regional Pain Syndrome is a multifactorial disorder with clinical features of neurogenic inflammation, nociceptive sensitisation (which causes extreme sensitivity or allodynia), vasomotor dysfunction, and maladaptive neuroplasticity, generated by an aberrant response to tissue injury. Though treatment is often unsatisfactory, early multimodal therapy can cause dramatic improvement or remission of the syndrome in some patients.
CRPS is associated with dysregulation of the central nervous system and autonomic nervous system resulting in multiple functional loss, impairment and disability.
Type I, formerly known as reflex sympathetic dystrophy (RSD), Sudeck's atrophy, reflex neurovascular dystrophy (RND), or algoneurodystrophy, does not have demonstrable nerve lesions. With the vast majority of patients diagnosed with CRPS being of this type, most of the literature thus refers to type I.
Type II, formerly known as causalgia, has evidence of obvious nerve damage. Type II CRPS tends towards the more painful and difficult to control aspects of CRPS; type II scores 42 out of 50 on the McGill pain scale (however there is seemingly little or no data pertaining to type I specifically here). In Type II the "cause" of the syndrome is the known or obvious injury, although the cause of the mechanisms of CRPS Type II are as unknown as the mechanisms of Type I.
CRPS has the unfortunate honor of being described as the most painful syndrome or disease, scoring highest on the McGill pain scale (42), above such events as amputation of a digit and childbirth. Lack of social awareness has inspired patients to campaign for more widespread knowledge of CRPS and lack of clinical awareness has led to the creation of support groups seeking to self-educate with the latest research.
Evidence suggests that CRPS has both physical and psychological factors. Whilst "research does not reveal support for specific personality or psychopathology predictors of the condition" there are psychosocial factors to CRPS (such as reduced quality of life and impaired occupational function) and psychological problems (which include increased depression and anxiety). Unsurprisingly, there is overwhelming evidence of limbic system involvement. Sadly very poor quality of life for some has led to CRPS also being called "The Suicide Disease" which has motivated appeals for greater understanding
CRPS is associated with dysregulation of the central nervous system and autonomic nervous system resulting in multiple functional loss, impairment and disability.
Type I, formerly known as reflex sympathetic dystrophy (RSD), Sudeck's atrophy, reflex neurovascular dystrophy (RND), or algoneurodystrophy, does not have demonstrable nerve lesions. With the vast majority of patients diagnosed with CRPS being of this type, most of the literature thus refers to type I.
Type II, formerly known as causalgia, has evidence of obvious nerve damage. Type II CRPS tends towards the more painful and difficult to control aspects of CRPS; type II scores 42 out of 50 on the McGill pain scale (however there is seemingly little or no data pertaining to type I specifically here). In Type II the "cause" of the syndrome is the known or obvious injury, although the cause of the mechanisms of CRPS Type II are as unknown as the mechanisms of Type I.
CRPS has the unfortunate honor of being described as the most painful syndrome or disease, scoring highest on the McGill pain scale (42), above such events as amputation of a digit and childbirth. Lack of social awareness has inspired patients to campaign for more widespread knowledge of CRPS and lack of clinical awareness has led to the creation of support groups seeking to self-educate with the latest research.
Evidence suggests that CRPS has both physical and psychological factors. Whilst "research does not reveal support for specific personality or psychopathology predictors of the condition" there are psychosocial factors to CRPS (such as reduced quality of life and impaired occupational function) and psychological problems (which include increased depression and anxiety). Unsurprisingly, there is overwhelming evidence of limbic system involvement. Sadly very poor quality of life for some has led to CRPS also being called "The Suicide Disease" which has motivated appeals for greater understanding
