Complex regional pain syndrome

Diagnosis of complex regional pain syndrome (CRPS) is based on a physical exam and your medical history. There's no single test that can definitively diagnose CRPS, but the following procedures may provide important clues:

• Bone scan. This procedure might help find bone changes. A radioactive substance injected into one of your veins allows your bones to be seen with a special camera.
• Sweat production tests. Some tests can measure the amount of sweat on both limbs. Uneven results may indicate CRPS.
• X-rays. Loss of minerals from your bones may show up on an X-ray in later stages of the disease.
• Magnetic resonance imaging (MRI). Images captured with an Magnetic resonance imaging (MRI) test may show tissue changes that rule out other conditions.

There's some evidence that early treatment might help improve symptoms of CRPS. Often, a combination of different treatments, tailored to your specific case, is necessary. Treatment options include:

Medications

Doctors use various medications to treat the symptoms of CRPS.

• Pain relievers. Pain relievers available without a prescription — such as aspirin, ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) — may ease mild pain and inflammation.

  Your doctor may prescribe stronger pain relievers if over-the-counter (OTC) ones aren't helpful. Opioid medications might be an option. Taken in low doses, they might help control pain.

• Antidepressants and anticonvulsants. Sometimes antidepressants, such as amitriptyline, and anticonvulsants, such as gabapentin (Gralise, Neurontin), are used to treat pain that originates from a damaged nerve (neuropathic pain).
• Corticosteroids. Steroid medications, such as prednisone, may reduce inflammation and improve mobility in the affected limb.
• Bone-loss medications. Your provider may suggest medications to prevent or stall bone loss, such as alendronate (Binosto, Fosamax) and calcitonin (Miacalcin).
• Sympathetic nerve-blocking medication. Injection of an anesthetic to block pain fibers in the affected nerves may relieve pain in some people.
• Intravenous ketamine. Some studies show that low doses of intravenous ketamine, a strong anesthetic, may substantially alleviate pain.
• Medicines to lower blood pressure. Sometimes high blood pressure medications, including prazosin (Minipress), phenoxybenzamine (Dibenzyline) and clonidine can help to control pain.

Therapies

• Heat therapy. Applying heat may offer relief of swelling and discomfort on skin that feels cool.
• Topical analgesics. Various topical treatments are available that may reduce hypersensitivity, such as capsaicin cream available without a prescription, or lidocaine cream or patches (Lidoderm, ZTlido, others).
• Physical or occupational therapy. Gentle, guided exercising of the affected limbs or modifying daily activities might help decrease pain and improve range of motion and strength. The earlier the disease is diagnosed, the more effective exercises might be.
• Mirror therapy. This type of therapy uses a mirror to help trick the brain. Sitting before a mirror or mirror box, you move the healthy limb so that the brain perceives it as the limb that is affected by CRPS. Research shows that this type of therapy might help improve function and reduce pain for those with CRPS.
• 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. Your provider inserts tiny electrodes along your spinal cord. A small electrical current delivered to the spinal cord results in pain relief.
• Intrathecal drug pumps. In this therapy, medications that relieve pain are pumped into the spinal cord fluid.
• Acupuncture. The insertion of long, thin needles may help stimulate nerves, muscles and connective tissue to increase blood flow and relieve pain.

It's possible for CRPS to recur, sometimes due to a trigger such as exposure to cold or intense emotional stress. Recurrences may be treated with small doses of an antidepressant or other medication.

Living with a chronic, painful condition can be challenging, especially when — as is often the case with CRPS — your friends and family don't believe you could be feeling as much pain as you describe. Share information from reliable sources about CRPS with those close to you to help them understand what you're experiencing.

Follow these suggestions to take care of your physical and mental health:

• Maintain typical daily activities as best you can.
• Pace yourself and be sure to get the rest that you need.
• Stay connected with friends and family.
• Continue to pursue hobbies that you enjoy and are able to do.

If CRPS makes it difficult for you to do things you enjoy, ask your provider about ways to get around the obstacles.

Keep in mind that your physical health can directly affect your mental health. Denial, anger and frustration are common with chronic illnesses.

At times, you may need more tools to deal with your emotions. A therapist, behavioral psychologist or other professional may be able to help you put things in perspective. He or she may also be able to teach you coping skills, such as relaxation or meditation techniques.

Sometimes joining a support group, where you can share experiences and feelings with other people, is a good approach. Ask your provider what support groups are available in your community.

To get the best medical care, take time to prepare for your appointment.

What you can do

Write down any symptoms you're experiencing — including the severity and location of your pain, stiffness or sensitivity. It's also a good idea to write down any questions you have for your provider.

Examples of questions you might ask your provider include:

• What's the likely cause of my symptoms?
• What kinds of tests, if any, do I need?
• Is my condition temporary or possibly chronic?
• What types of treatments are available? Which do you recommend?
• What are the alternatives to the primary approach that you're suggesting?
• I have these other health conditions. How can I best manage them together?
• Is there a generic alternative to the medicine you're prescribing for me?
• Are there any brochures or other printed material that I can take home? What websites do you recommend?

In addition to the questions that you've prepared to ask your provider, don't hesitate to ask additional questions during your appointment.

What to expect from your doctor

Your provider is likely to ask you a number of questions. Being ready to answer them may leave time to go over any points you want to spend more time on. For CRPS, your provider may ask:

• Have you had a recent accident, illness or injury, such as trauma to your limbs, a heart attack or an infection?
• Have you had surgery recently?
• When did you first begin experiencing pain or burning?
• How long have you been experiencing your symptoms?
• Is the pain occasional or continuous?
• Does anything seem to improve or worsen your symptoms?
• Have you experienced similar symptoms after past injuries?