The following four criteria are used to diagnose CRPS-
- An initiating noxious event is responsible for the patient’s immobilization.
- The patient has continuing pain, allodynia, or hyperalgesia that is disproportionate to any inciting event.
- Edema, changes in skin blood flow, or abnormal sudomotor activity in the region of the pain.
- The syndrome is excluded by the existence of a condition that would otherwise account for the degree of pain and dysfunction.
The cause of the syndrome may not be evident. In CRPS type I (also called as reflex sympathetic dystrophy), minor injuries or fractures of a limb precede the onset of symptoms. CRPS type II (also called causalgia) develops after an injury to a major peripheral nerve.
Treatment should be started as early as possible and most importantly directed toward restoration of full function of the extremity.
NSAIDs, Opioids, antidepressants(amitriptyline), and anticonvulsants (gabapentin, pregabalin), are used to treat pain that originates from a damaged nerve (neuropathic pain). Corticosteroids, such as prednisone, may reduce inflammation, useful during acute CRPS. Your doctor may suggest bone-loss medications, such as alendronate and calcitonin. Other medications like Sodium channel blockers ( Lignocaine IV), NMDA receptor blockers (Ketamine, flupirtine, dextromethorphan) are also used. Topical analgesics may reduce hypersensitivities, such as lidocaine, capsaicin or a combination of ketamine, clonidine, and amitriptyline.
Treatment Options Or Interventions
- Sympathetic Neurolysis like Stellate Gangli block, Lumbar Sympathetic Block, etc.
- Spinal Cord Stimulator
- Lignocaine / Ketamine Infusion
- Sympathetic ganglion blocks
- Physical therapy, psychological therapy: Gentle, guided exercising of the affected limbs may improve range of motion and strength. Careful contralateral physical therapy should be the acute treatment of choice. Applying heat and cold also helps
- Transcutaneous electrical nerve stimulation (TENS). Chronic pain is sometimes eased by applying electrical impulses to nerve endings.
- Biofeedback. In some cases, learning biofeedback techniques may help. In biofeedback, you learn to become more aware of your body so that you can relax your body and relieve pain.
- Spinal cord stimulation & intrathecal clonidine is considered in refractory cases.