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Complex regional pain syndrome

Definition

It is a chronic progressive disease characterized by severe pain, swelling and changes in the skin. There is no cure.

There are 2 types:

• Type I, formerly known as reflex sympathetic dystrophy (RSD), Sudeck's atrophy, reflex neurovascular dystrophy (RND) or algoneurodystrophy, does not have demonstrable nerve lesions.
• Type II, formerly known as causalgia, has evidence of obvious nerve damage.

The cause of this syndrome

Currently unknown.

Precipitating factors:

• Injury
• surgery,
• Some cases have no demonstrable injury to the original site.

Pathophysiology

1. Central nervous system (CNS) sensitization, are key neurologic processes that appear to be involved in the induction and maintenance of CRPS.
2. N-methyl-D-aspartate (NMDA) receptor has significant involvement in the CNS sensitization process.
3. Elevated CNS glutamate levels promote "physiological wind-up" and CNS sensitization.
4. Trauma related cytokine release, exaggerated neurogenic inflammation
5. Sympathetic afferent coupling
6. Adrenoreceptor pathology
7. Glial cell activation
8. Cortical reorganization
9. Oxidative damage (e.g. by free radicals)

Susceptibility

• CRPS can strike at any age, but the mean age at diagnosis is 42.
• CRPS has been diagnosed in children as young as 2 years old.
• CRPS is 3 times more frequent in females than males.
• Investigators estimate that 2-5 percent of those with peripheral nerve injury, and 13-70 percent of those with hemiplegia (paralysis of one side of the body), will suffer from CRPS.
• Cigarette smoking was strikingly present in patients about 68%.

Symptoms of Complex regional pain syndrome

The following are some of the symptoms of Complex regional pain syndrome :

• The symptoms of CRPS usually manifest near the site of an injury.The most common symptoms overall are burning and electrical sensations, described to be like "shooting pain."
• The patient may also experience muscle spasms, local swelling, abnormally increased sweating, changes in skin temperature and color, softening and thinning of bones, joint tenderness or stiffness, restricted or painful movement.
• The pain of CRPS is continuous and may be heightened by emotional or physical stress.
• Moving or touching the limb is often intolerable

Following are the types of disease progression:

1. Type one: severe, burning pain at the site of the injury. Muscle spasm, joint stiffness, restricted mobility, rapid hair and nail growth, and vasospasm (a constriction of the blood vessels) that affects color and temperature of the skin can also occur.
2. Type two: is characterized by more intense pain. Swelling spreads, hair growth diminishes, nails become cracked, brittle, grooved, and spotty, osteoporosis becomes severe and diffuse, joints thicken, and muscles atrophy.
3. Type three: is characterized by irreversible changes in the skin and bones, while the pain becomes unyielding and may involve the entire limb. There is marked muscle atrophy, severely limited mobility of the affected area, and flexor tendon contraction, limb is displaced from its normal position, and marked bone softening and thinning is more dispersed.

Diagnosis CRPS types I and II share the common diagnostic criteria shown below.
Thermography
Sweat testing
X-rays
Electrodiagnostics
Sympathetic blocks

Prevention

Vitamin C has been shown to reduce the prevalence of complex regional pain syndrome

Homeopathic treatment for Complex regional pain syndrome

The general strategy in CRPS treatment is often multi-disciplinary, with the use of different types of medications combined with distinct physical therapies.

a) Drugs

• antidepressants
• anti-inflammatories: corticosteroids
COX-inhibitors
• vasodilators
• GABA analogs
• alpha- or beta-adrenergic-blocking compounds
• entire pharmacy of opioids

Although many different drugs are used, there is not much supportive evidence for most of them.

b) Physical and occupational therapy

• Graded Motor Imagery and Mirror box Therapy
• Physical therapy has been used under light general anesthesia

c) Tactile discrimination training

d) Graded exposure to fearful activities

e) Local anesthetic blocks/injections

f) Spinal cord stimulators

g) Sympathectomy

h) Collateral meridian therapy

i) Ketamine

Prognosis

Good progress can be made in treating CRPS if treatment is begun early, ideally within 3 months of the first symptoms
Homeopathy:

Homeopathy works nicely in pain management. As per the underlying cause, Homeopathy has to offer good results.

Treated cases on Complex regional pain syndrome

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