CRPS or RSD
WHAT IS CRPS or RSD?
Complex Regional Pain Syndrome or CRPS which was formerly known as Reflex Sympathetic Dystrophy or RSD is considered to be a multi-system syndrome or condition that is mainly characterised by chronic pain that usually begins in one area of the body. CRPS can affect any part of the body and usually it will begin in one particular area but can then spread further.
According to the Royal College of Physicians (RCP) Guidelines for CRPS (2012), they state that Complex Regional Pain Syndrome (CRPS) is:
Complex regional pain syndrome (CRPS) is a debilitating, painful condition in a limb, associated with sensory, motor, autonomic, skin and bone abnormalities.
From the Royal College of Physicians’ (UK) guidelines for CRPS, it can be said that CRPS is:
- A debilitating painful chronic condition in a limb or extremity
- It is associated with sensory, motor, autonomic, skin & bone abnormalities
- Pain is the leading symptom and is usually out of proportion to the original or inciting event
- It is often associated with limb dysfunction
- It causes psychological distress – CRPS is not caused by psychological issues or mental health problems
- It often arises after an injury to a limb
CRPS first described in 17th Century and then later more commonly known is the description during the American Civil War by Silas Weir Mitchell. For more information about the history of CRPS, why not visit What is CRPS/RSD
WHAT TYPES OF COMPLEX REGIONAL PAIN SYNDROME (CRPS/RSD) ARE THERE?
There are two (2) main different types of COMPLEX REGIONAL PAIN SYNDROME (CRPS). These are:
TYPE 1 or CRPS I
CRPS I or Type I used to be known as REFLEX SYMPATHETIC DYSTROPHY (RSD). There are still many people including doctors and specialists who still refer to CRPS as RSD.
CRPS I or CRPS Type I, occurs after an illness or an injury that did NOT directly damage a nerve. It usually occurs after a minor or major tissue injury to the extremities.
According to the Mayo Clinic’s web page Complex Regional Pain Syndrome, they say:
“About 90 percent of people with complex regional pain syndrome have type 1.”
TYPE 2 or CRPS II
CRPS Type II or CRPS II used to be known as CAUSALGIA. CRPS Type II occurs after there has been an actual known injury to a nerve.
Even though there are the 2 types of CRPS/RSD, the signs and symptoms are almost the same for both types. Have a look at the Stages and Symptoms page to learn more about the signs and symptoms of Complex Regional Pain Syndrome (CRPS).
According to the Budapest Criteria, there is another diagnostic type or rather sub-type of CRPS which is CRPS Not Otherwise Specified (CRPS-NOS). According to the RCP UK guidelines CRPS-NOS is a type of CRPS:
“…for patients who do not fully meet the criteria but whose signs and symptoms could not be explained better by another diagnosis. For patients who fulfilled the Budapest criteria in the past but no longer do so, the term CRPS-NOS may also be used. “
HOT and COLD CRPS
You may also hear 2 other expressions concerning CRPS which are: Warm / Hot CRPS and Cold CRPS. These 2 terms are seen as diagnostic terms rather than symptoms of the condition.
WARM or HOT CRPS
The warm or hot type of CRPS is seen by Doctors and specialists as the ‘acute’ phase of the affected CRPS limb or CRPS area.
The majority of sufferers with CRPS are often classed in this hot or warm type. 70% of CRPS sufferers will have the warm or hot type CRPS and 30% will have the Cold CRPS (Eberle, T et al 2009).
According to a recent study by Dirckx, M et al (2015) the warmer CRPS side:
” …inflammation is generally assumed to be present “
If diagnosis is made early or if symptoms have appeared soon after injuries, surgery or otherwise then the term of hot or cold is often used by doctors and specialists. There will usually be a distinct temperature difference between the CRPS affected limb and the non affected limb or limbs. Most sufferers won’t have been told of their hot or cold type this may have been because diagnosis was too late. At the initial stages of the condition sufferers with CRPS Type I will often have a warmer affected limb, however eventually when the Type I becomes chronic, the CRPS affected limb will then turn cold.
According to Wasner, G et al. (2001) :
“…in CRPS I, unilateral inhibition of sympathetic vasoconstrictor neurones leads to a warmer affected limb in the acute stage.”
The term Cold CRPS usually is referred to in the chronic stages of the condition. Sufferers with this type will have lower McGill Pain Questionnaire (MPQ) results showing that there is increased central nervous system involvement as well as a higher chance of dystonia.
If you have been diagnosed with CRPS Type II (also known as Causalgia) you will most likely have had a diagnosis much earlier than sufferers with CRPS Type I. This is because for those suffering with CRPS Type II, there has been a known direct injury to a nerve it will increase the probability of vasoconstriction causing the cold temperature straight away.
Unfortunately if you have been diagnosed with Type I Cold CRPS a study by Vaneker, M. et al (2005) stated that:
“…cold CRPS 1 patients have poorer clinical pain outcomes and show persistent signs of central sensitisation correlating with disease progression. The latter is not the case for warm CRPS 1 patients.”
Again in the research study by Wasner, G. et al (2001) they said this about the cold CRPS Type I:
“Secondary changes in neurovascular transmission may lead to vasoconstriction and cold skin in chronic CRPS I, whereas sympathetic activity is still depressed.”
HOW DOES CRPS BEGIN?
Here’s a diagram to help explain how CRPS begins and the cycle the CRPS goes in. The diagram shows that:
- The original injury initiates a pain impulse carried by the sensory nerves to the central nervous system
- The pain impulse in turn triggers an impulse in the sympathetic nervous system, which returns to the original site of the injury
- The sympathetic impulse triggers the inflammatory response causing the vessels to spasm and leads to swelling and increased pain
- The pain triggers another response establishing a cycle of pain and swelling
- Resulting condition with redness, swelling and lower temperature (Please visit SIGNS & SYMPTOMS page for more details on symptoms)
- American Academy of Pain Medicine (2013) ‘Complex Regional Pain Syndrome: Practical Diagnostic and Treatment Guidelines, 4th Edition,’ Pain Medicine. 2013. Vol 14, pp 180-229. Available from: <http://onlinelibrary.wiley.com/doi/10.1111/pme.12033/epdf>
- Complex Regional Pain Syndrome. MedLine Plus part of National Institutes of Health. Available from: <http://www.nlm.nih.gov/medlineplus/ency/article/007184.htm>
- Dirckx, M et al (2015) ‘Inflammation in cold Complex Regional Pain Syndrome,’ Acta Anaesthesiologica Scandinavia. 2015, January. Vol 59 Issue 6. pp 733-739. Available from: <http://onlinelibrary.wiley.com/doi/10.1111/aas.12465/abstract> doi: 10.1111/aas.12465
- Eberle, T. et al. (2009) ‘Warm and cold complex regional pain syndromes – Differences beyond skin temperature?,’ Neurology. 2009, 10 February. Vol 72 Number 6. pp 505-512. Available from: <http://www.neurology.org/content/72/6/505> doi: 10.1212/01.wnl.0000341930.35494.66
- Mayo Clinic (2014) ‘Complex Regional Pain Syndrome,’ Mayo Clinic Website. 2014, April 12. Available from: <http://www.mayoclinic.org/diseases-conditions/complex-regional-pain-syndrome/basics/causes/con-20022844>
- Royal College of Physicians (RCP) (2012) ‘Complex Regional Pain Syndrome in Adults: UK Guidelines for diagnosis, referral and management in primary and secondary care,’ RCP London UK, May 2012. Available from: <https://www.rcplondon.ac.uk/sites/default/files/documents/complex-regional-pain-full-guideline.pdf>
- Vaneker, M. et al (2005) ‘Patients initially diagnosed as ‘warm’ or ‘cold’ CRPS 1 show differences in central sensory processing some eight years after diagnosis: a quantitative sensory testing study,’ Pain. 2005, May. Vol 115(1-2). pp 204-211. Available from: <http://www.ncbi.nlm.nih.gov/pubmed/15836983> doi: 10.1016/j.pain.2005.02.031
- Wasner, G. et al. (2001) ‘Vascular abnormalities in reflex sympathetic dystrophy (CRPS I): mechanisms and diagnostic value,’ Brain. 2001. Vol 124. pp 587-599. Available from: <http://brain.oxfordjournals.org/content/brain/124/3/587.full.pdf> doi: 10.1093/brain/124.3.587
As you can see there are 2 main types of CRPS/RSD which are Type I and Type II. There is a 3rd sub-type which is CRPS-NOS. The terms hot or warm CRPS and cold CRPS are not seen as sub-types but more of an explanation of the stages that a sufferer goes through in each type ie from acute phase to chronic phase.
Last Updated: 04/05/2017