Complex Regional Pain Syndrome (CRPS):
CRPS, formerly known as RSD, is a rare neuro-inflammatory disorder that causes severe inflammation in the sympathetic nervous system. CRPS is believed to be caused by damage to, or malfunction of, the peripheral and central nervous system. The central nervous system is composed of the brain and spinal cord; the peripheral nervous system involves nerve signaling from the brain and spinal cord to the rest of the body.
Symptoms in the affected area are typically:
Although the key symptom is pain that:
- Dramatic changes in skin temperature, color, or texture
- Intense burning pain
- Extreme skin sensitivity
- Swelling and stiffness in affected joints
- Decreased ability to move the affected body part
Although the key symptom is pain that:
- Is intense and burning, and is usually much stronger than would be expected for the type of injury that occurred.
- Gets worse, rather than better over time.
- Begins at the point of injury, but may spread to the whole limb, or in some cases, to the arm or leg on the opposite side of the body.
It is uncertain why some individuals develop CRPS while others with similar trauma do not. Studies say that close to 90 percent of all CRPS cases the condition is triggered by a clear history of trauma or injury. The most common triggers are fractures/sprains, a soft tissue injury (example: cuts, burns, or bruises), limb immobilization, surgery or sometimes even minor medical procedures such as a splinter. The biggest thing to know about CRPS, is that it represents an abnormal response that magnifies the effects of the actual injury.
crps explained in plain english:
Imagine a pretty bad paper cut. One that hurts pretty decent, but you constantly forget about. Because you can’t see it. Now picture squeezing Lemon Juice or Rubbing Alcohol on it every twenty minutes. That’s CRPS in a nut shell. What starts as something small, keeps reminding you constantly by nagging you with pain. What once started at skin level…has been irritated non stop…eventually starts hurting in the muscle…to so deep down in the bone, the pain becomes unbearable.
the medical part of crps:
Peripheral nerve abnormalities found in the individuals with CRPS usually involve the small unmyelinated and thinly myelinated sensory nerve fibers (axons) that carry pain messages and signals to blood vessels. (Myelin is a mixture of proteins and fat-like substances that surround and insulate some nerve fibers.) Because small fibers in the nerves communicate with blood vessels, injuries to the fibers may trigger the many different symptoms of CRPS. Molecules secreted from the ends of hyperactive small fibers are thought to contribute to inflammation and blood vessel abnormalities. These peripheral nerve abnormalities in turn trigger damage in the spinal cord and brain.
National Institute of Neurological Disorders and Stroke. Complex Regional Pain Syndrome. NIH, January 2017.
- Blood vessels in the affected limb may dilate (open wider) or leak fluid into the surrounding tissue, causing red, swollen skin. The dilation and constriction of small blood vessels is controlled by small nerve fiber axons as well as chemical messengers in the blood. The underlying muscles and deeper tissues can become starved of oxygen and nutrients, which causes muscle and joint pain as well as damage. The blood vessels may over-constrict (clamp down), causing cold, white, or bluish skin.
- CRPS also affects the immune system. High levels of inflammatory chemicals (cytokines) have been found in the tissues of people with CRPS. These contribute to the redness, swelling and warmth reported by many affected.
- CRPS is more common individuals with other inflammatory and autoimmune conditions, such as Arthritis.
National Institute of Neurological Disorders and Stroke. Complex Regional Pain Syndrome. NIH, January 2017.
Are crps and rsd the same condition?
Yes, they are the same condition.
Over the last five centuries that CRPS has been described, it has had over 200 different names in the English language alone. CRPS is the current name for this condition, but it was previously named Reflex Sympathetic Dystrophy. RSD is now known as CRPS Type 1 or CRPS 1.
Over the last five centuries that CRPS has been described, it has had over 200 different names in the English language alone. CRPS is the current name for this condition, but it was previously named Reflex Sympathetic Dystrophy. RSD is now known as CRPS Type 1 or CRPS 1.
What types of Complex regional pain syndrome (crps) are there?
There is one Main type of CRPS and three subtypes of Complex Regional Pain Syndrome (CRPS) according to the Valencia Consensus-Based Adaption of the IASP Complex Regional Pain Syndrome Diagnostic Criteria (2019). These are:
Main Type:
Subtypes:
At the IASP Valencia Consensus, the researchers and consultants involved decided that the terms Warm/Hot CRPS, Intermediate CRPS, and Cold/Blue CRPS are not classed as Complex Regional Pain Syndrome sub-types, but more of an explanation of the stages that a person living with CRPS go through in each type, i.e. from acute phase to chronic phase.
Main Type:
- Type 1 or CRPS I
Subtypes:
- Type 2/CRPS II
- CRPS - Not otherwise specified (CRPS-NOS)
- CRPS With Some Remitting Features
At the IASP Valencia Consensus, the researchers and consultants involved decided that the terms Warm/Hot CRPS, Intermediate CRPS, and Cold/Blue CRPS are not classed as Complex Regional Pain Syndrome sub-types, but more of an explanation of the stages that a person living with CRPS go through in each type, i.e. from acute phase to chronic phase.
Main Type: Type 1 or Crps i
- Type 1 or CRPS 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. Type 1 Or CRPS I occurs after an illness or injury that did NOT directly damage a nerve. It usually occurs after a minor or major tissue injury to the extremities. Type 1 will usually develop from injuries including (but not limited to) soft tissue damage, sprains or fractures (not nerve related).
Subtypes:
- Type 2 or CRPS II: used to be known as causalgia and occurs after there has been an actual injury to a nerve.
- CRPS-NOS: According to the Budapest Criteria, there is another diagnostic type of CRPS, or rather a sub-type of CRPS. This is known as CRPS - Not Otherwise Specified or CRPS-NOS. This third sub-type of CRPS, CRPS-NOS, was added because approximately 15% of patients previously diagnosed with CRPS (based on 1994 ISAP criteria) would not fully meet the new clinical diagnostic Budapest Criteria (Sebastin, S.J. et al 2011). According to the RCP UK guidelines (2018) 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."
- CRPS with some Remitting Factors: This is a new sub-type as agreed under the Valencia Consensus, which overlaps with either CRPS I or II.
This sub-type is for patients who have been previously diagnosed or documented as having fully met the CRPS criteria (either CRPS I or CRPS II) but who are currently not displaying sufficient CRPS symptoms to fully meet the diagnostic criteria.
Subgroups
You may also hear other expressions concerning Complex Regional Pain Syndrome (CRPS), such as Warm/Hot CRPS, Intermediate CRPS and Cold/Blue CRPS. These three terms are seen as diagnostic terms or sub-groups of CRPS, rather than symptoms of the condition.
Warm/Hot/Red 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 CRPS sufferers will have this Warm or Hot type, with 70% of CRPS classed as having the Warm or Hot Type CRPS, compared to the 30% with the Cold or Blue CRPS (Eberle, T et al 2009).
According to a recent study by Dirckx, M et al (2015), for 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 typically used by the doctors and specialists. There will usually be a distinct temperature difference between the CRPS affected limb (or area) when compared to a non-affected limb (or area). Most CRPS sufferers won't have been told of their hot or cold type, possibly because diagnosis was too late.
At the initial stages of Complex Regional Pain Syndrome, 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. In the Warm or Hot phase of CRPS, it will often display the classic signs of inflammation (Veldmen, P.H. et al 1993). You will also find a greater pressure hyperalgesia on the affected CRPS limb or area (Vaneker, M. et al 2005).
According to Wasner, G. et al (2001): "...in CRPS I, unilateral inhibition of sympathetic vasoconstrictor neurons leads to a warmer affected limb in the acute stage."
Intermediate CRPS:
Intermediate Complex Regional Pain Syndrome (CRPS) is where the CRPS affected limb or area is neither Warm or Hot nor Cold or Blue (Wasner, G, et al 2001) (Dirckx, M et al 2015).
Cold or Blue CRPS:
The term Cold or Blue CRPS is usually is referred to in the chronic stages of Complex Regional Pain Syndrome. Bruehl, S. et al (2010) found that the transition from Warm or Hot CRPS to Cold or Blue CRPS in common CRPS. CRPS patients 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 patients with CRPS Type I. This is because for those living with CRPS Type II, there has been a known direct injury to a nerve, therefore it will increase the probability of vasoconstriction causing the cold temperature straight away.
Unfortunately, according to a study by Vaneker, M. et al (2005), "...cold CRPS I patients have poorer clinical pain outcomes and show persistent signs of central sensitization correlating with disease progression. The latter is not the case for warm CRPS I patients."
In the research study by Wasner, G. et al (2001), they said oft 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."
Warm/Hot/Red 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 CRPS sufferers will have this Warm or Hot type, with 70% of CRPS classed as having the Warm or Hot Type CRPS, compared to the 30% with the Cold or Blue CRPS (Eberle, T et al 2009).
According to a recent study by Dirckx, M et al (2015), for 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 typically used by the doctors and specialists. There will usually be a distinct temperature difference between the CRPS affected limb (or area) when compared to a non-affected limb (or area). Most CRPS sufferers won't have been told of their hot or cold type, possibly because diagnosis was too late.
At the initial stages of Complex Regional Pain Syndrome, 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. In the Warm or Hot phase of CRPS, it will often display the classic signs of inflammation (Veldmen, P.H. et al 1993). You will also find a greater pressure hyperalgesia on the affected CRPS limb or area (Vaneker, M. et al 2005).
According to Wasner, G. et al (2001): "...in CRPS I, unilateral inhibition of sympathetic vasoconstrictor neurons leads to a warmer affected limb in the acute stage."
Intermediate CRPS:
Intermediate Complex Regional Pain Syndrome (CRPS) is where the CRPS affected limb or area is neither Warm or Hot nor Cold or Blue (Wasner, G, et al 2001) (Dirckx, M et al 2015).
Cold or Blue CRPS:
The term Cold or Blue CRPS is usually is referred to in the chronic stages of Complex Regional Pain Syndrome. Bruehl, S. et al (2010) found that the transition from Warm or Hot CRPS to Cold or Blue CRPS in common CRPS. CRPS patients 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 patients with CRPS Type I. This is because for those living with CRPS Type II, there has been a known direct injury to a nerve, therefore it will increase the probability of vasoconstriction causing the cold temperature straight away.
Unfortunately, according to a study by Vaneker, M. et al (2005), "...cold CRPS I patients have poorer clinical pain outcomes and show persistent signs of central sensitization correlating with disease progression. The latter is not the case for warm CRPS I patients."
In the research study by Wasner, G. et al (2001), they said oft 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."
"Yes, hello, I'd like a refund on my body. It's kinda defective and really needy."
- anyone with a chronic illness
The nerves of CRPS:
Your nervous system is involved in everything your body does, from regulating your breathing to controlling your muscles to sensing heat or cold. Your body contains three types of nerves.
And just a reminder, CRPS is believed to be caused by damage to, or malfunction, of the peripheral and central nervous system. The central nervous system is composed of the brain and spinal cord. Whereas the peripheral nervous system involves nerve signaling from the brain and spinal cord to the rest of your body.
Inflammation is typically characterized as swelling. Irritated. Redness. Heat.
Now imagine that all together.
Nerves…Inflamed. And constantly sending different areas of your body signals.
The human body has nearly 46 miles of different nerves in length, all tangled up in your body. Which can allow for many different signals to be made. Which is why, each and every CRPS patient experiences their CRPS differently.
- Autonomic Nerves- they control the involuntary or partially voluntary activities. Including: blood pressure, temperature control, heart rate, and digestion.
- Motor Nerves- they control your movements and actions by passing info to your brain and spinal cord to your muscles.
- Sensory Nerves- These nerves relay information from your skin and muscles back to your brain and spinal cord. That information is then processed to let you feel good and bad (pain) sensations.
And just a reminder, CRPS is believed to be caused by damage to, or malfunction, of the peripheral and central nervous system. The central nervous system is composed of the brain and spinal cord. Whereas the peripheral nervous system involves nerve signaling from the brain and spinal cord to the rest of your body.
Inflammation is typically characterized as swelling. Irritated. Redness. Heat.
Now imagine that all together.
Nerves…Inflamed. And constantly sending different areas of your body signals.
The human body has nearly 46 miles of different nerves in length, all tangled up in your body. Which can allow for many different signals to be made. Which is why, each and every CRPS patient experiences their CRPS differently.
