by Lisa Pavese, FNP, Tory McJunkin, MD, and Paul Lynch, MD.
Reflex Sympathetic Dystrophy Diagnosis
Reflex sympathetic dystrophy is a very complex pain disorder that can be very difficult to treat. Reflex sympathetic dystrophy often begins in the hand or the foot and spreads to the affected arm or leg. CRPS can also spread to the opposite arm or leg.
The cause of reflex sympathetic dystrophy is still unclear; however, there are several theories. Some theorize that reflex sympathetic dystrophy is maintained by the sympathetic nervous system. Another theory is that CRPS is caused by an immune response that leads to the inflammatory symptoms of redness, warmth, and swelling in the affected area.
There are no specific tests to diagnose CRPS, but testing can be done to rule out other diagnoses that may explain the symptoms. Blood testing can be done to rule out other inflammatory or rheumatologic conditions. Nerve conduction studies can be done to rule out peripheral neuropathy or nerve entrapment conditions. Magnetic resonance imaging (MRI) can be done to rule out any soft tissue causes for the patient’s neuropathic symptoms. The diagnosis of CRPS is made in the absence of these other possible causes for the patient’s pain.
Reflex Sympathetic Dystrophy TreatmentThe typical treatment for CRPS includes nerve blocks for pain reduction, desensitization treatments with a physical therapist, and medications that help with neuropathic pain. Some nerve blocks for upper extremity pain include stellate ganglion blocks, cervical epidural steroid injections, and interscalene blocks, followed by desensitization. Injections for lower extremity CRPS include lumbar sympathetic nerve blocks, lumbar epidural steroid injections, and femoral sciatic nerve blocks, followed by desensitization. Some medications used for CRPS include gabapentin, pregabalin (Lyrica), duloxetine (Cymbalta), and amitriptyline.
If the patient does not respond to more conservative treatments, neuromodulation through spinal cord stimulation may be considered. Spinal cord stimulation involves placing small electrodes within the epidural space of the spine. The theory behind spinal cord stimulation is that stimulation of the large nerve fibers will inhibit the small nerve fibers, thus blocking the sensation of pain. Peripheral nerve stimulation is very similar to spinal cord stimulation, but the electrodes are placed along the peripheral nerves, typically close to the area of pain. Spinal cord stimulation has been a very efficacious treatment modality for over 30 years. A study by Forouzanfar and Kemler, et al (2003) indicates that spinal cord stimulation provides pain relief to between 42-47% of patients suffering from CRPS of the upper and lower extremities.
CRPS is a very complex pain disorder that can be very difficult to treat. The physicians at Arizona Pain Specialists incorporate cutting-edge biomedical technologies, along with more conservative treatment modalities, to provide a comprehensive approach to your pain. Call us today to schedule an appointment!
- Farouzanfar, T., Kemler, M., and Weber, W., et al (2004). Spinal Cord Stimulation in Complex Regional Pain Syndrome: Cervical and Lumbar Devices are Comparably Effective. British Journal of Anaesthesia, 2004.
- Kim, Philip (2004). Advanced Pain Management Techniques: An Overview of Neurostimulation. Retrieved February 16, 2010 from: http://www.medscape.com/viewarticle/473431
- National Institute of Neurologic Disorders and Stroke (2009). NINDS Complex Regional Pain Syndrome Information Page. Retrieved December 4, 2009 from: http://www.ninds.nih.gov/disorders/reflex_sympathetic_dystrophy/reflex_sympathetic_dystrophy.htm
- Rho R., Brewer R., and Lamer T., et al. (2002). Complex Regional Pain Syndrome. Mayo Clinic Proceedings, 2002; 77: 174-180.