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Stages of Complex Regional Pain Syndrome

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Complex regional pain syndrome, abbreviated as CRPS, is defined by the National Institute of Neurological Disorders and Stroke (NINDS) as a chronic pain condition that stems from problems with the nervous system, either the central or peripheral nervous system. The National Institutes of Health (NIH) states that one of two forms of CRPS can occur: type one is a chronic nerve disorder that affects the arms and legs after a minor injury, and type two is from nerve injury. Nerve conditions, like CRPS and neuropathy, affect the body's ability to control movements, sensations and autonomic functions.

The NIH states that a patient with CRPS can go through three stages of the disorder. However, not all patients experience CRPS the same: some patients may stay in stage one, while other patients may have a faster progression.

Stage One

The first stage of CRPS has a month to three months duration. During this stage, the patient has increased hair and nail growth, and dry and thin skin that changes color. Severe pain is also present: the pain moves through the limb, becomes worse when the affected limb is touched, and has a burning or aching sensation.

Stage Two

The second stage of CRPS lasts longer, with a three to six months duration. The hair growth reverses, and the patient has significant changes in her skin texture and color. The swelling also increases, resulting in stiff muscles and joints.

Stage Three

By stage three, the damages from CRPS are irreversible. The pain and muscle problems have become progressively worse, with pain throughout the affected limb, muscle contractions that involve the tendons and muscles, limited movements and muscle wasting. During this phase, the patient can also experience depression or other changes in mood.

The Mayo Clinic notes that the spread of symptoms in CRPS follow one of three patterns: continuity type, mirror-image type and independent type. With continuity type, the pain and muscular problems spread in a logical pattern, such as up the leg to the torso. The mirror-image type pattern results in a spread of symptoms to the opposite limb, while the independent type pattern has the spreading of symptoms to a random part of the body.

The prognosis of CRPS varies. The NINDS states that some patients have spontaneous remission, while others have irreversible damage. While there is no cure, multiple treatment options are available to help control the symptoms. Physical therapy helps with mobility problems, and psychotherapy treats mood problems that result from the disorder. Medications, like topical analgesics, corticosteroids, anti-seizure drugs, antidepressants, and opioids are used for pain management. Other options include sympathetic nerve block, intrathecal drug pump (direct drug administration to the spinal fluid), and spinal cord stimulation. Another treatment, surgical sympathectomy, which destroys the nerves involved in the disorder, is controversial and its effectiveness is debated.
Elizabeth Stannard Gromisch received her bachelor’s of science degree in neuroscience from Trinity College in Hartford, CT in May 2009. She is the Hartford Women's Health Examiner and she writes about abuse on Suite 101.

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September 17, 2016 - 10:40am

thank you for trying to correct the way people think i have had rsd/crps since 01 mine was from an I.V. it has now caused me to also have fibromyalgia.ankylosing spodilytus hypothyroidism adrenal problems and my face has completely atrophied on the left side it is hard enough to be in pain all the time but now to watch my face become a big indention or caved in beacause i now have parrry romberg syndrome which is another autoimune disease is devastating we need help making people understand hoew horrible this thing is and we need help raising awareness if you can please reach out to us or if you know someone who will not just talk to the medical community but to the people suffering everyday from this thing it would be so helpful i have a support group here in oklahoma and 75 percent of them are homebound from this thing we call rsd we need help getting the word out because this needs to be caught in the first three months if possible but because their is not one test to confirm this syndrome most drs. do not even know what it is i was just in the hospital for 24 hours and only one doctor or nurse knew what i have that is terrible this is whty we need the word to get out that this is real

August 11, 2010 - 6:51pm

Thank you for writing about this monster than invaded my life over 2 years ago. Many of us refer to this disorder by it's old name Reflex Sympathetic Dystrophy (RSD) or a conjunction of the two names RSD/CRPS. I often feel like an orphan because this disorder is so unknown, even within the medical community. I think a great part of the confusion results from the may names associated with this disorder. I carry with me to share and to educate others. I have provided each of my doctors and my dentist with information about the disorder

I do have some problems with yor article. There is CRPS-1 which is the result of an unknown nerve injury and CRPS-2 is the result of a known injury. In my case is was a broken wrist from a car accident. Both types of CRPS are a neurological disorder of the central nervous system that manifests in the extremeties (arms and legs). The severity of CRPS is NOT related to the severity of the injury. Both types of CRPS can spread to include the whole body. There is no way to predict how, when and how much it will spread.

The concept of staging is a dying concept, and many look at CRPS as being on a continuum. The concept of staging is mentioned by CRPS experts for historical purposes. Many CRPS patient can have symptoms/characteristics of more than one stage at the same time and they skip a stage as this disease progresses.

CRPS is a very complex disorder that does not follow any timeline or sequence. And each patient does not exhibit the same symptoms. For this reason many times patients are misdiagnosed and treated for many other conditions. The typical CRPS patients will see an average of 5 doctors before getting the correct diagnosis. This results in a delay of the proper treatment, often leading to permanent disability.

There is no one standard treatment. Physical therapy is employed to help a patient to maintain mobility and use of a limb. A wide range of medications are employed to control the many symptoms ranging from swelling to movement disorders. Each treatment regiment is tailored to the individual.

This disorder is filled with controversity because there does not seem to be a standard knowledge taught to doctors in medical schools. Talk to 10 Pain Management doctors and you will get 10 different descriptions and 10 different treatment protocols. I have had 2 Pain Management doctors with completely different opinions of the concept of spreading. My first doctor say it did not spread and my second said it does but mainly in the continuous pattern. What this controversity/ lack of standard knowledge does is leave many patients suffering.

For more information go to RSDHope.org, RSDSA.org and rsdrx.com. These groups focus only on the topic of RSD/CRPS and will provide the most current and up to date information.


February 20, 2010 - 1:02pm
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We value and respect our HERWriters' experiences, but everyone is different. Many of our writers are speaking from personal experience, and what's worked for them may not work for you. Their articles are not a substitute for medical advice, although we hope you can gain knowledge from their insight.

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