What is CRPS (Complex Regional Pain Syndrome)?
What is RSD (Regional Sympathetic Dystrophy)?
Understanding what CRPS or Complex Regional Pain Syndrome is can help to quickly diagnose the problem, in the hope of a full recovery. Informing families, friends, carers and sufferers with detailed information on what CRPS is, can be vital in order to manage the condition.
CRPS (Complex Regional Pain Syndrome) was formally known as RSD (Reflex Sympathetic Dystrophy) is considered to be a multi-system disorder characterised by severe pain; pathological changes of the bones, joints, and skin; excessive sweating; tissue swelling; and hypersensitivity to light touch. It is generally categorised as 1 one of 2 (two) types. (Brence, J. 2014)
Complex Regional Pain Syndrome (CRPS) or Reflex Sympathetic Dystrophy (RSD) is a painful, debilitating, chronic, sometimes progressive, poorly understood condition that affects approximately 5% of all injuries that occur. However the condition won’t tend to progress in everyone so much so it causes severe aggravating pain and other painful symptoms. Visit our CRPS/RSD page to learn in more detail what CRPS (Complex Regional Pain Syndrome) is, the different types of CRPS and how the CRPS causes a pain cycle to start.
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CRPS occurs when both the nervous system and immune system malfunction as they respond to any tissue damage from trauma. The nerves will misfire, sending constant pain signals to the brain. It will usually occur within 1 or more areas of the body typically legs, arms, feet and hands. However it has been known to be in the face, eyes, internal organs and other parts of the body. The main characteristics of it are EXTREME CONSTANT BURNING PAIN that lasts a long time after the incident occurred and is out of proportion to the original injury, swelling (medical term being oedema in UK English and in USA English it is edema), extreme colour and temperature changes along with other different signs and symptoms for CRPS/RSD that will be looked into in depth within the SIGNS and SYMPTOMS page. The level of pain from Complex Regional Pain Syndrome (CRPS) is measured on the McGill pain index or scale and is the most severe pain on that scale. Visit our Pain Scale page to see a visual form of that scale.
According to the Yaguda,B. et al. (2014) they said that:
“Complex regional pain syndrome (CRPS) is a chronic, predominantly neuropathic and partly musculoskeletal pain disorder often associated with autonomic disturbances. It is divided into 2 types, reflecting the absence or presence of a nerve injury.”
Please remember that it has been proved through research that Complex Regional Pain Syndrome or CRPS is a physical condition despite what you may hear from a medical professional. Some medical professionals believe that the condition is caused by previous psychological problems, it is NOT. The condition can causes future psychological problems because of the constant amount of pain. Prior psychological or mental health issues don’t predetermine CRPS. CRPS is not in your mind!
According to the NINDS factsheet on CRPS, they state that CRPS is:
“CRPS is believed to be caused by damage to, or malfunction of, the peripheral and central nervous systems. The central nervous system is composed of the brain and spinal cord, and the peripheral nervous system involves nerve signaling from the brain and spinal cord to the rest of the body.”
The names for Complex Regional Pain Syndrome / Reflex Sympathetic Dystrophy (CRPS/RSD) as you will see have changed and evolved just like the research of the condition has. As different symptoms have been found the names have changed in some way. This has been by adding or subtracting different phrases or words or actually combining them. See DIFFERENT NAMES FOR CRPS page
TYPES of CRPS
There are two (2) different types of COMPLEX REGIONAL PAIN SYNDROME (CRPS). These are:
TYPE 1 or CRPS I
CRPS type 1 is what used to be known as (RSD) REFLEX SYMPATHETIC DYSTROPHY. There are still many people including doctors and specialists who still refer to CRPS as RSD. It occurs after an illness or an injury that did NOT directly damage a nerve. It is usually a minor or major tissue injury to the extremities. (Mayo Clinic – Causes of CRPS)
TYPE 2 or CRPS II
CRPS Type 2 used to be known as CAUSALGIA. This occurs after there has been a known injury to a nerve.
Even though there are the 2 types of CRPS/RSD, the stages and symptoms are the same for both types.
HOT and COLD CRPS
You may have heard of the terms Hot or Warm CRPS and Cold CRPS. Visit our CRPS/RSD page for more details on these terms.
HISTORY of COMPLEX REGIONAL PAIN SYNDROME
After this in the late 1700’s, a British surgeon and one of the founders of orthopaedics by the name of Sir Percivall Pott recognised atrophy and burning pain in injured extremities.
The first written description of CRPS was made by Dr. Denmark, a British surgeon that worked at the Royal Navy Hospital in Hampshire. He published a case report who had been wounded by a bullet that’s had passed through his upper arm. Dr Denmark found that even though the soldier’s wound had healed, the soldier’s forearm was bent and he had a “burning” pain that was so severe the soldier was always sweating. Unfortunately at the time Dr Denmark’s accurate clinical case report was ignored until a few decades later other clinical cases of gunshot wounds that occurred in the American Civil War were not ignored.
After this, the next description was by SILAS WEIR MITCHELL MD during the American Civil War (1861-1865), is the one that most academics refer to as the birth of CRPS. Silas Weir Mitchell MD was an American doctor who during the war treated soldiers with nervous conditions or injuries and those with gunshot wounds. By the end of the Civil War he had become a neurology specialist. His description of persistent burning pain around 1864 felt by those soldiers whose bullets had been removed a long while ago was eventually called CAUSALGIA which is what everyone knows today as Complex Regional Pain Syndrome / Reflex Sympathetic Dystrophy (CRPS/RSD). Mitchell believed that the burning pain was because of an injury to a nerve and in his book from 1872, “Injuries of Nerves and Their Consequences,” he wrote that the pain that the soldiers and veterans felt was “the most terrible of all the tortures which a nerve wound may inflict.” Silas Mitchell found that the location of the pain did differ in every patient but that it had mainly concentrated in the hand or the foot.
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Dr. JEAN-MARTIN CHARCOT was the French doctor who began thinking that the condition caused swelling, temperature and colour changes were shown as signs. However he was the doctor that began to say that it CRPS was a product of our brain’s thinking and suggesting it to us – i.e. psychosomatic, autosuggestion if you like. The neurologist outlined it as hysteria minor and even now there are doctors and specialists that will say that it is a disease or disorder that has been auto-suggested – or even in your head!
One of the other main doctors concerned with Complex Regional Pain Syndrome / Reflex Sympathetic Dystrophy was called Dr.PAUL HERMAN MARTIN SUDECK who was a German doctor who lived 1866-1945. Sudeck was the doctor where we get the phrases such as Sudeck’s Dystrophy or Sudeck Atrophy (this was later known as Reflex Sympathetic Dystrophy (RSD)) Sudeck’s Disease or Sudeck’s Syndrome. He first described the condition in around 1900 and discussed the possible cause of over response following an accident that caused an injury, bone break or surgery. Sudeck also said that it was inflammation reply which had various symptoms or signs that included amongst other things pain and differing colours. There was also the discussion with the Sudeck’s Atrophy of osteoporosis. As you know these things are all what we use now as indicator signs and symptoms of modern day CRPS/RSD.
Another military surgeon, a Frenchman named Dr. RENE LERICHE was known for also treating soldiers with nerve damage but this was during World War I. He wrote about what we would know as the characters of ‘modern’ Complex Regional Pain Syndrome. His idea of getting rid or ease the pain was to perform a sympathectomy (this is an operation where the sympathetic nerve is cut mainly to ease the pain) on the soldiers, as he believed this was the successful treatment for CRPS/RSD. We would consider this a very last resort now, but then it was very different and little true knowledge as little was known at that time. Leriche talked about sweating of the skin, intense burning pain and the mental side of the condition. He was constantly distressed at the constant burning pain the soldiers were having and he wrote the ‘Surgery of Pain’ (‘La Chirugie de la Douleur’) in 1937.
Around 1936 there was also a German student called REIDER and he was a pupil of Dr. Sudeck. Reider decided that because of the way the condition travels that the phrase ‘Reflex’ and because he saw the bone tissues wasting the used the term ‘limb dystrophy.’
The next major authority for Complex Regional Pain Syndrome/Reflex Sympathetic Dystrophy again another military doctor in and around the time of World War II, he was WILLIAM K. LIVINGSTON MD and who lived 1879-1966. His job saw him at a Naval Hospital in USA and he mainly dealt with soldiers who had problems with chronic pain because of damage to their Peripheral Nervous System (PNS). The PNS consists of nerves and any nerve cell clusters (Ganglia) which are outside of the spinal cord and the brain. Its main job is to communicate between the central nervous system and the limbs. Livingston spoke about the pain spreading to other limbs and is also known as the forbearer of the foundation of chronic pain that we actually still use today. Livingston developed more Leriche’s theory of the ‘Catch-22’ or the theory of the vicious circle.
Osteoporosis was again authenticated by another German Doctor; ROBERT KIENBÖCK. He believed that CRPS/RSD osteoporosis was down to not using the limb thereby causing muscle and bone wastage. A variation of CRPS was also deliberated by the Doctor called Kienböck’s atrophy or Kienböck’s syndrome. This is simply very much like CRPS / RSD and it has acute bone wastage.
Over the history of CRPS/RSD there have been many other doctors and surgeons who have added more signs, symptoms and name for the modern day Complex Regional Pain Syndrome. These eminent people included a doctor by the name of Dr. JAMES EVANS just after World War II in approximately 1946 he devised the term of REFLEX SYMPATHETIC DYSTROPHY(RSD) and he thought that there was contribution of hyperactivity of the sympathetic nervous system. The term of RSD was then used right up to the 1993/1994 conference of the International Association of the Study of Pain (IASP) when we finally have what the term is today – COMPLEX REGIONAL PAIN SYNDROME (CRPS.) There was ‘Shoulder-hand Syndrome’ the brainchild of a doctor named STEINBROCKER in around 1947. A few years later in approximately 1953 and he started the use of steroids by mouth or as they medically known ‘corticsteroids.’ Another doctor was HANNINGTON-KIFF who began to treat CRPS/RSD with the intravenous blocks using Guanethidine in around 1974.
To try and diagnose the chronic pain condition and some of its symptoms, various types of methods were used. Those included were the ‘Three Phase Nuclear Scans’ instigated by a doctor named FRANKLIN KOZIN (still used now in diagnosis) in the USA. Nuclear scans also originated in France by a doctor called SERRE, H. Temperatures of the limbs of suspected CRPS/RSD patients had the thermography assessed by using a reflecting telescope, and then later DR R. LAWSON produced recordings of temperatures from American soldiers suspected of having the condition during the Korean War.
After all of the different terminology, symptoms and ways of diagnosing the condition in around 1995 Dr. JUDITH A. PAICE wrote that even though a name for the condition had been decided in the IASP, still after 130 years of discussion nobody would agree to the best way of treating the condition, how it is caused or even what to name it. So, CRPS or Complex Regional Pain Syndrome is the name for the moment, but who knows this may change again in the future.
Did you know there’s been over 200 different names for CRPS? Why not check out some of those other names for CRPS on our Different Names page?!
SO… After all of the History of CRPS, the chronic and progressive pain condition – we are still not really any clearer to understanding the reasons of how it happens, why it happens, what we can do to treat the symptoms even if we can’t treat the actual chronic pain disorder. We need to try and reduce or even stop the symptoms from progressing using research. Understanding what CRPS/RSD is, and the 2 main types of CRPS – CRPS Type I and CRPS Type II, are integral parts of living with this condition and starts you on the road to acceptance.
CITED RESEARCH / STUDIES / ARTICLES
- Brence, J. (2014) ‘Physical Therapist’s Guide to Complex Regional Pain Syndrome (CRPS),’American Physical Therapy Association. 2014, May 21. Available from: <http://www.moveforwardpt.com/SymptomsConditionsDetail.aspx?cid=31c5d12d-2fd4-4723-949d-ad741d4c71d7>
- Bruehl, S. (2010). ‘An Update on the Pathiophysiology of Complex Regional Pain Syndrome‘ Anesthesiology.Vol 113, pp 713-725. Available from: <http://anesthesiology.pubs.asahq.org/article.aspx?articleid=1933227 > September 2010. doi: 10.1097/ALN.0b013e3181e3db38
- Jänig, W & Baron, R. (2002) ‘Complex regional pain syndrome is a disease of the central nervous system,’ Clin Auton Res. 2002. Vol 12, pp 150–164. Available FULL TEXT from: <https://www.researchgate.net/profile/Wilfrid_Jaenig/publication/11140157_Complex_regional_pain_syndrome_is_a_disease_of_the_central_nervous_system/links/0f31753b66d15e3f20000000.pdf> doi: 10.1007/s10286-002-0022-1
- Maihofner, C et al. (2010). ‘Complex Regional Pain Syndromes: new pathophysiological concepts and therapies,’European Journal of Neurology Vol.17, pp. 649-660. 18 February 2010. Available from: < http://onlinelibrary.wiley.com/doi/10.1111/j.1468-1331.2010.02947.x/full > doi: 10.1111/j.1468-1331.2010.02947.x
- Mayo Clinic Staff, (12 April 2014) ‘Causes of Complex Regional Pain Syndrome,’ April 2014.Mayo Clinic website. Available from: <http://www.mayoclinic.org/diseases-conditions/complex-regional-pain-syndrome/basics/causes/con-20022844>
- Moseley, L. (2009) ‘What is Complex Regional Pain Syndrome – In plain English,’Body In Mind website. 2009. Available from: <http://www.bodyinmind.org/what-is-complex-regional-pain-syndrome-in-plain-english/>
- Sebastin, S. J. (2011), ‘Complex Regional Pain Syndrome,’Indian Journal of Plastic Surgery,‘ May-August 2011. Vol 44, no.2, pp. 298-307. Available from: <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3193642/> doi: 10.4103/0970-0358.85351
- Turner-Stokes, L. & Goebel, A. (2011) ‘Complex Regional Pain Syndrome: Concise Guidance to good practice series,’RCP website. December 2011. Vol 11. No. 6 pp 596-600. Available from: <https://www.rcplondon.ac.uk/sites/default/files/documents/complex-regional-pain-syndrome-concise-guidance.pdf>
- Yaguda,B. et al. (2014) ‘Complex Regional Pain Syndrome: Pathophysiology, Diagnosis, and Treatment,’ Pain Medicine News. 2014, 10 December. Available from: <http://painmedicinenews.com/Review-Articles/Article/12-14/Complex-Regional-Pain-Syndrome-Pathophysiology-Diagnosis-and-Treatment/28988>
- National Institute of Neurological Disorders & Stroke website Fact Sheet on Complex Regional Pain Syndrome (2015) ‘Complex Regional Pain Syndrome Fact Sheet,’ NINDS website. Last Update 4 September 2015. Available from: <http://www.ninds.nih.gov/disorders/reflex_sympathetic_dystrophy/detail_reflex_sympathetic_dystrophy.htm>
- NETHERLANDS – Netherlands Society of Anaesthesiologists & Netherlands Society of Rehabilitation Specialists (November 2014)‘Updated EBGD Guidelines for Complex Regional Pain Syndrome Type 1 2014,’ Full Guidelines Available from: <http://pdver.atcomputing.nl/pdf/Executive_summary_updated_guidelines_CRPS_I_2014.pdf>
- Pain Relief Foundation – Complex Regional Pain Syndrome
- UK – Royal College of Physicians (December 2011) ‘UK Guidelines for diagnosis, Referral & Management in Primary & Secondary Care, Complex Regional Pain Syndrome in Adults,’ Available from: < https://www.rcplondon.ac.uk/resources/complex-regional-pain-syndrome-guidelines>
- USA – 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>
Last Updated: 29/05/2017