What is complex regional pain syndrome?

Complex regional pain syndrome is a type of ongoing pain that often affects your arms or legs. It could appear after a stroke, heart attack, or injury, but its cause isn’t entirely clear. Treatment at Pain Medicine Group can give you the pain relief you need to maximize your quality of life.

What are the symptoms of complex regional pain syndrome?

Common signs and symptoms of complex regional pain syndrome include:

• Throbbing or burning arm or leg pain
• Swelling
• Redness
• Skin temperature changes
• Touch sensitivity
• Temperature sensitivity 
• Skin color changes
• Hair or nail growth changes
• Skin texture changes
• Joint stiffness or damage
• Muscle spasms or tremors
• Muscle loss or weakness
• Decreased movement in affected areas
• Cold or pale skin
• Tissue wasting
• Muscle tightening

 

Some of these symptoms are irreversible, which is why early diagnosis and treatment of complex regional pain syndrome is important.

What are the risk factors for complex regional pain syndrome?

While the cause of complex regional pain syndrome is a mystery and anyone can develop it, certain factors increase your risk for it. Examples include:

• Forceful trauma
• Fractures
• Crushing injuries
• Other injuries
• Some illnesses
• Nervous system abnormalities
• Past surgery
• Heart attack
• Infections
• Inappropriate inflammatory responses

How does my doctor diagnose complex regional pain syndrome?

There are several ways your Pain Medicine Group provider can diagnose complex regional pain syndrome. 

They discuss your symptoms and medical history and complete a physical examination. Your provider could suggest you undergo a bone scan, sweat production tests, MRIs, or X-rays to make a final diagnosis and detect or rule out other problems. 

What are common treatments for complex regional pain syndrome?

If you struggle with complex regional pain syndrome and want relief, your provider may recommend one of the following treatments:

Medications

Oral, topical, or intravenous (IV) medicines can reduce pain, inflammation, and complications linked with complex regional pain syndrome.

Heat therapy

Heat therapy can reduce the swelling and discomfort you may experience with complex regional pain syndrome.

Other therapies

Physical and/or occupational therapy can improve strength, reduce pain, and improve musculoskeletal function when you have complex regional pain syndrome. Mirror therapy can improve limb function and alleviate ongoing discomfort.

Acupuncture

The use of long, thin needles placed into strategic areas of your body can improve blood flow and reduce pain due to complex regional pain syndrome. 

Transcutaneous electrical nerve stimulation (TENS)

TENS uses noninvasive electrical impulses to target nerve endings and reduce ongoing pain.

Spinal cord stimulation

Your pain specialist can place a spinal cord stimulator under the skin near your spinal cord to deliver electrical currents that diminish pain signals.

Intrathecal drug pumps

Your doctor might recommend using intrathecal pumps to deliver medicine into spinal cord fluid and reduce ongoing discomfort.

Interventional Treatments

Interventional trearments such as stellate ganglion blocks (SGBs) and lumbar sympathetic blocks (LSBs) are used in the management of chronic regional pain syndrome (CRPS). CRPS is a chronic pain condition that typically affects an arm or leg, causing persistent pain, swelling, changes in skin color and temperature, and restricted mobility. SGBs and LSBs target the sympathetic nervous system, which plays a role in the development and maintenance of CRPS. Here's how these treatments work:

1. Stellate Ganglion Blocks (SGBs):
SGBs involve injecting a local anesthetic, such as lidocaine or bupivacaine, into the stellate ganglion, a cluster of nerves located in the neck on either side of the voice box. The stellate ganglion is a part of the sympathetic nervous system, which regulates involuntary functions, including blood flow and pain transmission.

By blocking the sympathetic activity in the stellate ganglion, SGBs can help to interrupt the pain signals and reduce inflammation associated with CRPS. The local anesthetic also has a numbing effect on the nerves, providing temporary pain relief. SGBs may be performed as a single injection or repeated over a series of treatments, depending on the individual's response.

2. Lumbar Sympathetic Blocks (LSBs):
LSBs involve injecting a local anesthetic around the sympathetic nerves in the lumbar region of the spine, specifically targeting the ganglion impar or lumbar sympathetic chain. The ganglion impar is a bundle of nerves located near the coccyx (tailbone), while the lumbar sympathetic chain refers to a series of ganglia along the lumbar spine.

LSBs work in a similar manner to SGBs by blocking sympathetic activity and reducing pain signals in the affected limb. By interrupting the sympathetic transmission, these blocks can help improve blood flow, decrease inflammation, and relieve pain associated with CRPS. LSBs are typically performed with the guidance of fluoroscopy (X-ray imaging) to ensure accurate needle placement.

Both SGBs and LSBs are typically performed as part of a multidisciplinary approach to CRPS management, including physical therapy, medications, and psychological support. The effects of these interventions can vary from person to person, and the duration of pain relief may also vary. In some cases, repeated or maintenance blocks may be necessary to sustain the benefits.

If you suspect you have complex regional pain syndrome and want relief, call the Pain Medicine Group office or schedule an appointment online today.