Complex Regional Pain Syndrome (CRPS): A Common Cause Of Chronic Pain

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By: Dr. John Conde DC, DACNB Special to the Boca and Delray newspapers
Complex regional pain syndrome (CRPS), formerly known as reflex sympathetic dystrophy syndrome (RSDS), is a condition of uncertain etiology that produces chronic pain. It is characterized by severe pain and sensitivity, swelling, and changes in the skin.  In some individuals, muscle atrophy and bone loss is seen.
Precipitating factors include previous injury or surgery however this is very often not the case.  A high correlation is seen with individuals with previous peripheral nerve injury, hemiplegia, and with smokers.  One of the following disease progressions are usually seen; Class 1 is characterized by severe burning pain at the site with rapid hair and nail growth and vasospasm (skin discoloration due to altered blood flow), Class 2 is characterized by severe pain and osteoporosis and muscle atrophy, Class 3 is characterized by unyielding pain which may involve the whole limb and muscle atrophy and tendon contractures.  CRPS is also divided in to two types; Type 1 does not demonstrate any demonstrable nerve injury, Type 2 does demonstrate objective signs of nerve injury.
Although the cause of CRPS is unknown, the physiological dysfunction is better understood.  Neurological inflammation is typically extensive within the nerve tissue locally and at the level of the spinal cord.  The inflammation irritates and triggers the pain nerves called nociceptors to fire more repeatedly.  In fact, the nociceptors become so efficient at transmitting pain that the system becomes self-sustaining and no longer requires a damaging stimulus to the tissue.  This process is called sensitization and is exemplified by an increase in the number of connections branching off the nerve cell and an increase in the speed of transmission of nerve impulses.  The pain transmission can becomes so extreme that the brain actually changes and adapts to this environment and further facilitates the pain cycle.  In essence, the brain undergoes maladaptive plasticity which means that it rearranges itself for a disadvantageous purpose.  Lastly, vasomotor changes occur at the tissue site exhibited as blood flow dysfunction that can cause swelling and discoloration.  These changes are secondary to improper functioning of the autonomic nervous system termed dysautonomia which controls blood vessel diameter.
Treatment is complex and multifactorial as pharmaceutical intervention is not effective for CRPS.  The goal of treatment is to reduce inflammation, stop the pain cycle locally and at the level of the spinal cord, re-establish proper brain integrity and promote adaptive plasticity, and institute proper autonomic control of vascularity.  The contemporary approach involves functional neurological rehabilitation to address CRPS.  This approach involves several cutting-edge modalities such as graded motor imagery, mirror therapy, Dynavision D2, and oculomotor techniques.  Nutrition and supplementation should be focused on reducing inflammation and stabilizing blood glucose levels.
Dr. John Conde is a Board Certified Chiropractic Neurologist, one of only one thousand in the country. He holds diplomate status through the American Chiropractic Neurology Board. He provides specialized care for difficult cases of back neck pain, numbness-tingling, vertigo-dizziness balance disorders, fibromyalgia, migraines, AD/HD, autism, and dyslexia. His office is located at the Atlantic Grove in Delray Beach, FL and can be reached at 561-330-6096, drconde@thecondecenter.com, and at www.thecondecenter.com