If you’re one of the millions of Americans who have been diagnosed with or are living with Complex Regional Pain Syndrome (CRPS) Jacksonville Spine Center’s Dr. Michael Hanes provides important information about living with CRPS, how to prepare for a surgical procedure and what you can do to prevent CRPS from spreading.

Here are some important things to know about managing CRPS .

LET’S START WITH AN OVERVIEW OF CRPS

CRPS (previously referred to as Reflex Sympathetic Dystrophy or RSD) is a form of neuropathic pain that usually affects an extremity but can involve any area of the body. It usually occurs after a trauma or surgery, but can also occur spontaneously. CRPS is more common in women and it can occur at any age. It severely impacts people’s lives, family and friends. It can make daily tasks and chores nearly very difficult. Simple things like putting on pants, or pulling a blanket over the impacted area can feel like thousands of needle stings or even a burning sensation. Circulation issues can also make the limb can appear blotchy, blue, purple, pale, or red and the limb could also feel warmer or cooler than the opposite limb. The symptoms can vary in severity and duration. Unfortunately, CRPS can also spread to other parts of the body over time, and this is often a very real fear for those suffering from CRPS.

CRPS is defined by International Association for the Study of Pain (IASP) as:

CRPS is defined by International Association for the Study of Pain (IASP) as:

1. Pain disproportionate to what would be expected after a trauma or lesion
2. Patient must report at least one symptom in 3 out of 4 of the following categories:
   • Sensory: Hyperalgesia and/or allodynia
   • Vasomotor: Temperature asymmetry and/or skin color changes and/or skin color asymmetry
   • Sudomotor/Edema: Edema and/or sweating changes and/or sweating asymmetry
   • Motor/Trophic: Decreased range of motion and/or motor dysfunction (weakness, tremor, dystonia) and/or trophic changes (hair, nail, skin)
3. Patient must display at least one sign at the time of evaluation in 2 or more of the above noted categories.
4. There must be no other diagnosis that better explains the symptoms.

HOW IS CRPS TREATED?

There are a variety of approaches to treating CRPS ranging from physical therapy to implantable technology.

Rehabilitation and physical therapy – Physical therapy for CRPS is focused on desensitization and graded motor imagery to help increase range of motion, strength, flexibility and function. Rehabilitation and occupational therapy can help prevent or reverse the secondary brain changes that are associated with chronic pain and can help patients learn new ways to work and perform daily tasks.

Psychological and Behavioral Therapy – This therapy focuses on patient and family education. Biofeedback can play an important role to help minimize the central sensitization that occurs with CRPS.

Medications – No drug is currently approved by the U.S. Food and Drug Administration

specifically for CRPS but patients have found relief with several medications particularly when used in the early stages of the disease. These include membrane stabilizers (gabapentin, pregabalin, topiramate), corticosteroids, calcium channel blockers, NSAIDs, and in some cases opioids.

Sympathetic nerve blocks – Sympathetic blocks involve injecting an anesthetic next to the spine to directly block the activity of sympathetic nerves and improve blood flow. Lumbar sympathetic blocks and stellate ganglion blocks are examples of sympathetic blocks to treat lower and upper extremity pain, respectively.

Surgical sympathectomy – This procedure destroys some of the nerves next to the spine. It is typically considered as a last line therapy when all other therapies have failed. is only recommended in patients whose pain is dramatically relieved by sympathetic nerve blocks.

Spinal cord/Dorsal root ganglion stimulation – Spinal cord and dorsal root ganglion stimulators can be used to treat CRPS affecting the upper or lower extremities. Electrodes are placed next to the spinal cord or dorsal root ganglion using a needle. Patients undergo a trial prior to implant to ensure that the therapy will work. If the patient has a successful trial (>50% relief), they will proceed with implant which involves placing the electrodes along with a small battery pack all underneath the skin.

Intrathecal drug pumps – These devices infuse pain-relieving medications directly into the spinal fluid surrounding the spinal cord. Targeting the pain signaling areas in the spinal cord uses less doses than if taken orally, which decreases side effects and increases drug effectiveness.

Ketamine – Ketamine is a potent anesthetic typically administered intravenously. Several studies have shown that infusions of ketamine administered over hours or days can provide significant, long-term relief for patients with CRPS.

Most importantly, CRPS is a complex disease that is best managed using a multidisciplinary approach involving multiple specialties, the patient, and family/friends.

HOW TO MINIMIZE THE SPREAD OF CRPS DURING SURGERY

A patient with CRPS already has a nervous system on high pain high alert so it’s extremely sensitive to new stimuli.

There are several precautions a patient can take to try to minimize the spread of CRPS when going in for a surgical procedure. Patients can request ask medical personnel to use the smallest needle possible for IV placement and ask to have it done by the most experienced personnel or directly by the anesthesiologist. IV fluids can be warmed prior to them being administered into your body. According to American RSDhope, these things may reduce the probability of causing a spike in your pain that can last after your surgery is over. None of these things are difficult for medical staff to do and may save you weeks or longer of much increased pain.

If possible avoid surgery in a limb affected with CRPS or at a minimum make sure that symptoms are reduced or absent at the time of surgery if surgery on that limb is required.

Sympathetic blocks and/or regional anesthesia can be performed prior to surgery and have been shown reduce the risk of CRPS spreading following surgical procedures. These can include, but are not limited to stellate ganglion blocks, lumbar sympathetic blocks, supraclavicular blocks, lumbar plexus blocks, epidural anesthesia, and spinal anesthesia.

Several IV and oral medications have been shown to reduce the risk of developing CRPS. Some of these include membrane stabilizers (gabapentin, pregabalin), Vitamin C, calcitonin, carnitine, corticosteroids, mannitol, and ketamine.

PAIN EXPERTS CAN BRING RELIEF

The medical experts at Jacksonville Spine and Pain Center can provide an accurate diagnosis of lower back pain and recommend a variety of treatments and procedures. Whether your pain is temporary or becoming more severe overtime, it’s important to discuss treatment options with your doctor before it limits your mobility and ability to live your life.

For more information on lower back pain or for any other pain relief procedures, call the Jacksonville Spine and Pain Center for an appointment. Jacksonville Spine and Pain Center is also a Veterans Choice Program. Call 904-223-3321 to get started today.