Living With Gastroparesis
When Melanie Dickens was 10 years old, she fell off a pair of stilts and injured her left leg. The injury triggered complex regional pain syndrome and led to…

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Complex Regional Pain Syndrome (CRPS) may not have a cure, but at UF Health, our dedicated team of pain medicine specialists is committed to slowing the progression of the disease and alleviating your symptoms. A pain specialist in our chronic pain clinic will use a holistic approach that focuses on pain management and improving your quality of life, empowering you to live as normally as possible.
Complex regional pain syndrome (CRPS) is a debilitating chronic pain condition that typically affects one limb following an injury but can also occur without any apparent cause. It is characterized by intense, persistent nerve pain, also known as neuropathic pain, and is accompanied by symptoms such as swelling and localized changes in skin color and temperature. The severity and duration of symptoms can vary, with some individuals experiencing long-term disability while others may see symptoms improve over time.
Complex regional pain syndrome has two types, though treatment for both is similar.
In most patients, complex regional pain syndrome is triggered by an injury and is thought to result from damage to the nervous system. This includes the nerves that control the blood vessels and sweat glands.
The damaged nerves are no longer able to properly control blood flow, sensation, and temperature in the affected area. This leads to problems in blood vessels, bones, muscles, nerves, and skin.
Most cases of CRPS are in patients who have suffered from a fracture in a limb, which was then immobilized in a cast.
But while CRPS is usually associated with trauma or injury, doctors are not sure why it is triggered in some patients but not others. In some cases, the sympathetic nervous system plays an important role in the chronic pain. Another theory is that CRPS is caused by a triggering of the immune response, which leads to the inflammatory symptoms of redness, warmth, and swelling in the affected area.
Possible causes of CRPS include direct injury to a nerve and injury or infection in an arm or leg.
In rare cases, sudden illnesses such as a heart attack or stroke can cause CRPS. The condition can sometimes appear without obvious injury to the affected limb.
CRPS can occur in anybody but is more common in women and peaks around 40 years of age. It is rare in the elderly and uncommon in young children.
Those with a family history of CRPS may be more likely to develop it early in life. Patients who smoke or have poor circulation, diabetes, autoimmune disorders, or previous injuries involving nerve damage may also be at higher risk.
The key symptom is severe pain that is prolonged and:
In most cases, CRPS has three stages. However, progression through the stages is not the same for everybody. Some people develop severe symptoms right away and others stay in the first stage.
Stage 1 (lasts 1 to 3 months):
Stage 2 (lasts 3 to 6 months):
Stage 3 (irreversible changes can be seen)
Complications that may result include:
There is no single test which can confirm CRPS, and so diagnosing it can be difficult. Additionally, many patients experience gradually improving symptoms over time, sometimes making it more difficult to diagnose as time goes on.
A health care provider will make a careful review of a patient’s medical history and perform a physical examination. Other tests may include:
Comprehensive testing will also help rule out whether a patient has a different condition with similar symptoms, such as arthritis or a muscle disease.
The main focus of treatment and pain management is on relieving the symptoms and helping people with this syndrome live as normal a life as possible.
Physical therapy and occupational therapy should be started early. Starting an exercise program and learning to keep joints and muscles moving may prevent the disease from getting worse. It can also help patients with everyday activities.
There are currently no medicines which have been specifically approved by the FDA for use in treating CRPS. Medications such as pain medicines, corticosteroids, certain blood pressure medicines, bone loss drugs, and antidepressants may provide pain relief in some patients.
Some type of talk therapy, such as cognitive behavioral therapy or psychotherapy, can help teach the skills needed to live with chronic pain.
Surgical or invasive techniques that may be tried:
Addressing factors which may impact the body’s ability to heal such as diabetes, tobacco use, or malnutrition may also improve a patient’s odds of recovering quickly.
No treatment or combination of treatments is guaranteed to be effective in every patient, and many treatments carry their own risks of complications. Each patient should work with their health care provider to develop a safe, personalized treatment plan.
Just as CRPS has different causes in different patients, outcomes are also highly variable from one patient to the next. Children and adolescents have a generally better prognosis than adults or the elderly.
Early diagnosis is always preferable. An early diagnosis allows for early and aggressive treatment of symptoms. If CRPS is diagnosed in the first stage, sometimes signs of the disease may disappear and normal movement is possible.
If the condition is not diagnosed quickly, changes to the bone and muscle may get worse and may not be reversible.
In some people, symptoms go away on their own. In others, CRPS pain continues even with treatment and the condition causes crippling, irreversible changes.
Contact your provider if you develop constant pain in an arm, leg, hand, or foot. Some patients describe the pain as burning, pins and needles, or as a squeezing sensation.
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https://permanent.fdlp.gov/gpo175228/CRPSFactSheetE508C.pdf
https://www.ninds.nih.gov/health-information/disorders/complex-regional-pain-syndrome
Deer TR, Levy RM, Kramer J, et al. Dorsal root ganglion stimulation yielded higher treatment success rate for complex regional pain syndrome and causalgia at 3 and 12 months: a randomized comparative trial. Pain. 2017;158(4):669-681. doi:10.1097/j.pain.0000000000000814
Oaklander A. Complex Regional Pain Syndrome (Reflex Sympathetic Dystrophy) & Posttraumatic Neuralgia. In: Stone JH. eds. Current Diagnosis & Treatment: Rheumatology, 4e. McGraw Hill; 2021. Accessed May 22, 2024. https://accessmedicine.mhmedical.com/content.aspx?bookid=3017§ionid=253715012
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When Melanie Dickens was 10 years old, she fell off a pair of stilts and injured her left leg. The injury triggered complex regional pain syndrome and led to…