There are 2 forms of Chronic Regional Pain Syndrome (CRPS): Type I or Reflex Sympathetic Dystrophy (RSD) and Type II or Causalgia, both of which are nerve-related pain conditions. Causalgia is secondary to a nerve injury, with the pain continuing even after the cause of pain is no longer present; RSD is secondary to an on-going sympathetic nervous system response in an extremity of the body and often has psychological dimensions. It is also controversial as a diagnosis.Although the reasons for RSD (CRPS, Type I) are not known, it has been associated with some of the following possible causalities: myocardial infarction, spinal cord disease, cerebral lesions, infections and repetitive motion disorder. It is also known to be often triggered by an injury to a body part and often to a minor injury.
In RSD, the sympathetic nervous system, regulating our “fight or flight” response has been activated by a stressor but fails to return to normalcy and “shut off” the response, sending of blood to the extremity with the concurrent dilation and constriction of the blood vessels. There are 3 phases of RSD: acute phase (1-3 months after injury), dystrophic phase (3-6 months after injury) and atrophic phase (6 and over months after injury). In all phases, pain is not proportional to the injury and does not follow along a nerve distribution. Patients recover in various phases, and the disorder is frequently misdiagnosed so that time ends up wasted since the condition can become chronic and permanent if not treated correctly in a timely manner, particularly within the first year.
RSD is diagnosed by various means, including bone scan, description of pain, X-ray, patient history, physical exam and sympathetic or stellate ganglion block. A positive result of the block is one way of confirming a diagnosis of RSD and is also therapeutic. Optimum treatment is considered to be a series of three sympathetic or stellate ganglion blocks together with pain medication most appropriately in a pain clinic under the care of an anesthesiologist. Neurologists and psychologists may also provide treatment, as well as biofeedback, acupuncture, and physical and occupational therapies.
Case management should include the appropriate selection of cases, assessment of the cases, the planning and implementation of treatment, education and pain management, and evaluation.
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