Molly S. Judge DPM, FACFAS

Chronic Pain

What is Chronic Regional Pain Syndrome

Podiatrist cronic pain

Chronic Regional Pain Syndrome (CRPS) is a disabling condition manifested byhyperalgesia, allodynia, trophic changes, and vasomotor disturbances. It can be a challenging problem for physicians as there are a variety of treatment options.
Two classifications exist: CRPS 1, once termed reflex sympathetic dystrophy (RSD), and CRPS II, previously causalgia. The only delineating factor is that frank nerve injury is associated with CRPS II. A civil war surgeon, Silas Weir Mitchell, first described the term causalgia in 1872 with nerve-associated injuries.
The term has a Greek origin from words meaning pain and burning. Other terms once used to describe this disease state include sympathetically maintained pain and sympathetically independent pain. It was not until 1994 that the International Association for the Study of Pain (IASP) established criteria and terminology for CRPS.

The underlying cause differs from person to person and can even change over time in the same individual. Proposed mechanisms include central and peripheral sensitization where the person’s own body mistakes normally non-painful stimuli as a painful response; altered cutaneous innervation; low norepinephrine levels; an impaired sympathetic nervous system; increased inflammatory markers; genetic influences; and psychological factors.
Symptoms vary which makes a diagnosis difficult. The triad of motor, sensory, and autonomic dysfunction is a classic finding, as patients will typically present with pain out of proportion and marked temperature differences between involved extremities.
Advanced imaging can also be useful. Increased peri-articular uptake is the most common finding on a tri-phasic bone scan. Electrodiagnostic studies may assist in making a diagnosis as well especially in CRPS II patients. Once a diagnosis has been made treatment maybe even more problematic as individual responses differ between patients

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Molly S. Judge DPM, FACFAS

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