With CRPS, pain emerges as the result of a previous trauma, but instead of healing over time, it becomes worse. To make things even more complicated, you begin to experience a range of additional symptoms, such as skin discoloration and sensory changes. Complex regional pain syndrome (CRPS) is excruciating and difficult to cope with. Fortunately, researchers continue to make progress as they search for potential new treatments for CRPS.
What is CRPS?
Complex regional pain syndrome (CRPS) is a chronic pain and sensory condition. In most cases, it affects the arms and legs after nerve damage occurs. This is classified as CRPS-II. The nerve damage causes the brain to send confusing and incorrect signals that lead to debilitating pain. While every case is different, CRPS typically develops after an injury, surgery, stroke, or heart attack.
Patients without a confirmed nerve injury are said to have CRPS-I, previously known as reflex sympathetic dystrophy syndrome (RSD). However, some research points to evidence of nerve injury in CRPS-I patients, which makes these classifications tricky. Because of this, some medical experts believe CRPS won’t be classified into two separate types in the future.
While burning and throbbing pain is the main symptom of CRPS, it can come with many other symptoms, including:
- Swelling of the area
- Sensitivity to touch or cold
- Skin temperatures changes
- Skin color and texture changes
- Muscle spasms
- Joint stiffness
- Changes in nail and hair growth
- Difficulty moving the affected area
Every case of CRPS is different. Symptoms may come and go or change over time. For some patients, the condition will go into remission. But others will experience intense pain and other symptoms for months or even years to come.
Who can get CRPS?
Because CRPS is related to nerve damage, it can affect men and women of all ages.
However, it is most common in women around the age of 40. It is incredibly rare to see CRPS in elderly people and children under the age of 10.
How is CRPS diagnosed?
At this point in time, there is no test that provides a clear CRPS diagnosis. Your doctor will evaluate your symptoms, as well as your medical history. This will include a close look at pre-existing health conditions, surgeries, medical procedures, and any injuries.
The symptoms of CRPS are similar to other conditions, such as arthritis, generalized muscle diseases, and even Lyme diseases. What sets CRPS apart from these is the correlation between symptoms and an injury to the affected area. Your doctor may perform certain tests to rule out these types of treatable conditions in order to confirm a CRPS diagnosis.
What are common CRPS treatments?
Researchers have discovered that treatment is most effective when started as early as possible. Your doctor will work to find a combination of treatment options for your specific case. These may include:
- Over-the-counter pain relievers
- Antidepressants and anticonvulsants
- Nerve blocks
- Intravenous ketamine
- Physical therapy
- Transcutaneous electrical nerve stimulation (TENS)
- Spinal cord stimulation
- Botulinum toxin (Botox) injections
- Topical local anesthetic creams and patches, such as lidocaine
5 new treatments for CRPS pain and symptom management
Unfortunately, there is currently no cure for CRPS, but doctors and scientists continue to research the condition.
Here is some of the cutting edge research into new treatments for CRPS, or the potential for new ones in the future.
1. Deep brain stimulation (DBS) for chronic pain shows promise
Deep brain stimulation (DBS) is a surgical procedure that involves implanting electrodes in the brain. These electrodes deliver electrical impulses that block or change the abnormal brain activity causing pain.
Previously, doctors have taken an analgesia-based approach, which is the inability to feel pain. However, a study conducted at Cleveland Clinic found that shifting the focus to areas of the brain that control emotion and behavior could provide better results. By manipulating the affective sphere of the brain, some patients will experience improved quality of life or relief from pain-related disability.
2. Study of the immunological causes for CRPS reveals possible treatment option
International researchers from across Europe came together to conduct a study into the immunological causes for CRPS. They looked at inflammation in the brain, especially when it comes to inflammatory mediators (messengers that act to promote a response).
One of these mediators is referred to as Interleukin (or IL-1). While it’s known to induce body responses for repair, there are a number of conditions in which IL-1 production seems to be partially to cause for the disease.
In this study, researchers transferred the antibodies from patients with CRPS to mice and found that these antibodies caused a CRPS-like condition. An important element of transferred CRPS was inflammation in pain-related parts of the mouse brains. The team found that by blocking IL-1 with a drug called anakinra, they could both prevent and reverse these changes in the mice.
According to Dr. Andreas Goebel of the University of Liverpool’s Pain Research Institute, the results support previous observations that patients with persistent CRPS should respond well to immune treatments.
3. Regenerative therapy case studies demonstrate the possibility of improved function
While regenerative therapy still requires more research and study, it has been promising in several case studies involving pain. A recent controlled study showed the effectiveness of platelet-rich plasma in carpal tunnel syndrome. The goal is to allow for self-healing by exposing injured tissue to a high volume of growth factors.
In one particular case of CRPS out of Colorado, a pediatric nurse practitioner suffered an injured nerve on the top of her hand after an IV start. This resulted in severe pain, as well as an inability to use her hand due to the onset of CRPS.
She visited Dr. Chris Centeno, MD of Centeno-Schultz Clinic and agreed to have platelet lysate carefully injected around the nerve to break up scarring. This allowed nerve function to improve about a month after the procedure. She reported continued improvement over the entire course of her treatments. Though it’s an isolated case, it may show the potential for more research into this treatment approach.
4. Identification of autoantibody response in complex regional pain syndrome
Using a mouse model of CRPS, several researchers from the Veterans Affairs Healthcare System worked to identify autoantigens in the skin of an affected limb. An autoantigen is usually a normal protein or protein complex that is instead recognized by the immune system of patients suffering from a specific autoimmune disease.
The results of the study stated:
“In addition to increased abundance, KRT16 demonstrated autoantigenicity, since sera from both fracture mice and CRPS patients showed increased autoantibody binding to recombinant kRT16 protein.”
Researchers say this is a critical step towards towards redefining CRPS as having an autoimmune set of causes. It may even pave the way for more mechanism-based therapies.
5. Neridronate approved as a treatment for type I complex regional pain syndrome in Italy
Neridronate was recently tested as a treatment for CRPS-I in a randomized, double-blind, placebo-controlled trial. Approximately 82 patients with CRPS-I in either the hand or foot were randomly assigned. Some received either an intravenous infusion of 100 mg of neridronate every three days (for a total of four times) or the placebo.
In the double-blind phase, the visual analog scale (VAS) for pain was significantly lower in the neridronate-treated group after 20 days of treatment. It continued to decrease for the following 20 days. Pain induced by passive motion, as well as increased sensitivity were significantly reduced in patients who were treated with neridronate compared to the placebo group.
The future of CRPS research
Doctors and scientists all over the world continue to research every facet of CRPS in order to better understand the condition, and in turn, find a cure. These are some of the studies that we can expect to learn from in the coming years.
Clinical evaluation of the effects of mirror therapy
Patients with CRPS-I will undergo a study at the Department of Physical Medicine and Rehabilitation, Hand Rehabilitation Unit at the Medical Faculty of Ankara University. The purpose is to research the clinical effects of CRPS alternative treatments, specifically mirror therapy.
Patients will be split into two groups (the mirror group and control group). The mirror group will receive mirror therapy for 30 minutes per day in addition to routine treatment. Mirror therapy will include several different flexing exercises, as well as various object grasping activities according to the status of the patient’s hand functions. Each patient will undergo a total of 20 sessions.
Every patient participating in the study will be assessed before and immediately after the treatment, as well as one month after the trial. Each assessment will include pain severity, grip strength, lateral pinch strength, hand circumference measurements, hand dexterity, hand function in daily living activities, and health-related quality of life.
Investigations of pathophysiology of dystonia and CRPS
Dystonia is a movement disorder in which a person’s muscles contract uncontrollably. The purpose of this study is to understand why people with CRPS often develop dystonia, and if these reasons are different in people with focal hand dystonia.
This detailed study will require participants to either stay at the clinical center for five or six days or have several different outpatient visits.
During testing, participants in the study will undergo MRI scans and transcranial magnetic stimulation (TMS) sessions. Participants with the ability to determine two separate stimuli as different will be tested by using a weak electrical shock to their fingers. They will also be asked to feel small plastic domes with ridges.
Low-dose naltrexone treatment for CRPS
Stanford Medicine’s Systems Neuroscience and Pain Lab is conducting a study sponsored by the Reflex Sympathetic Dystrophy Syndrome Association (RSDSA).
They believe there is significant evidence to suggest that the FDA-approved drug naltrexone can effectively treat certain types of pain, fatigue, and sleep disorders (in low doses). This will be the first official study of the effectiveness of LDN as a CRPS treatment medication.
Participation will last 14 to 28 weeks and gives patients an opportunity to receive LDN treatment at no cost. The study will require up to five in-person visits to Stanford, as well as weekly questionnaires and daily pain scores.
Learn more about new treatments for CRPS
The medical field is always changing. New technology and breakthroughs come as a result of years-long studies and research. If you’re living with CRPS, the best way to learn more is to work with a pain specialist.
At Arizona Pain, our team stays up-to-date on CRPS news and cutting edge techniques in pain relief. We have extensive experience working with patients who are experiencing chronic pain from CRPS. Our comprehensive approach allows us to tackle your pain from every angle.
Contact us to find out how we can help alleviate your symptoms through new treatments for CRPS.
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