COMPLEX REGIONAL PAIN SYNDROME
COMPLEX REGIONAL PAIN SYNDROME (CRPS), HAS BEEN KNOWN BY A NUMBER OF TERMS INCLUDING; REFLEX SYMPATHETIC DYSTROPHY SYNDROME, CAUSALGIA, SUDOMOTOR ATROPHY ETC. SYMPTOMS INCLUDE CONTINUOUS, INTENSE PAIN THAT GETS WORSE OVER TIME, SWELLING AND STIFFNESS IN AFFECTED JOINTS, RAPID OR NO HAIR AND NAIL GROWTH, AND CHANGES IN SKIN TEMPERATURE.
THIS CONDITION HAS BEEN DESCRIBED AS EARLY AS THE CIVIL WAR AS A RESULT OF GUNSHOT WOUNDS OR OTHER TRAUMA. THIS CONDITION USUALLY AFFECTS THE ARMS OR LEGS. IT IS A RESULT OF TRAUMA. CHRONIC REGIONAL PAIN SYNDROME CAN OCCUR AFTER A SEVERE CRUSHING INJURY WITH BROKEN BONES AND INJURED NERVES. A HISTORY OF A SEVERE FORCEFUL TRAUMATIC EVENT IS NOT A NECESSARY CHARACTERISTIC FOR THE DEVELOPMENT OF CHRONIC REGIONAL PAIN SYNDROME. THE INTENSITY OF THE INITIATING TRAUMA CAN APPEAR TO BE VERY SLIGHT. ONE CHARACTERISTIC DIAGNOSTIC PITFALL IS THAT THE PATIENT COMPLAINS OF VERY SEVERE PAIN THAT IS MUCH MORE SEVERE THAN THE CLINICIAN WOULD EXPECT CONSIDERING THE INITIAL INJURING EVENT. BECAUSE OF THIS SEEMINGLY ILLOGICAL DIFFERENCE BETWEEN THE RELATIVELY SMALL INTENSITY OF INJURING FORCE AND THE RESULTING VERY SEVERE PAIN COMPLAINTS, SOMETIMES PATIENTS ARE NOT TAKEN SERIOUSLY AND CHARACTERIZED AS COMPLAINERS RATHER THAN SOMEONE WITH A SEVERE INCAPACITATING PAIN CONDITION. THIS DIAGNOSIS TYPICALLY IS NOT MADE UNTIL AFTER MANY MONTHS OF INEFFECTIVE TREATMENTS.
AS THE CONDITION DEVELOPS THE ARM OR LEG CAN CHANGE COLORS, BECOME COLD, LOSE HAIR, AND GREATLY DIMINISH IN SIZE. IT HURTS SO MUCH FOR THE PATIENT TO MOVE THE ARM OR LEG THAT THEY AVOID ANY MOVEMENT AT ALL THE MUSCLES GET SMALLER. WHEN THE CONDITION REACHES THIS POINT WITH ALL OF THESE SERIOUS SYMPTOMS AND PHYSICAL CHARACTERISTICS, THE DIAGNOSIS IS EASIER TO MAKE BUT THE TREATMENT OF THE CONDITION IS MORE DIFFICULT.
AT THIS TIME THERE IS NO COMPELLING EXPLANATION WHY SOME PATIENTS DEVELOP THIS VERY SEVERE PAIN CONDITION AND OTHERS DO NOT. ONE OF MY PATIENTS CUT HER FINGER SLICING TOMATOES WHILE WORKING ON A FOOD TRUCK. SHE WOULD DEVELOP PAIN THAT WOULD CHANGE HER LIFE AND ONLY BE ALLEVIATED AFTER 2 OPERATIONS, MANY NERVE BLOCKS AND ACUPUNCTURE. A PATIENT WITH THIS CONDITION CAN RESPOND TO A LIGHT GENTLE TOUCH ON THE ARM, A SENSATION THAT COULD NORMALLY BE DESCRIBED AS PLEASANT, AS IF THEY WERE STABBED WITH A LARGE KNIFE.
TREATMENT OPTIONS:
IN THE PAST THIS CONDITION WAS TREATED BY OPERATIONS TO REMOVE PARTS OF THE SYMPATHETIC NERVOUS SYSTEM OR BY AMPUTATING THE PAINFUL ARM OR LEG. EVEN AFTER THESE DRASTIC METHODS THE PAIN CAN RETURN.
PERFORMING INJECTIONS TO DECREASE THE ACTIVITY OF THE SYMPATHETIC NERVOUS SYSTEM CAN ALMOST ALWAYS DECREASE THE PAIN DURING EACH INJECTION AND CAN SUBSTANTIALLY ALLEVIATE THE PAIN WHEN THE INJECTIONS ARE PERFORMED REPEATEDLY. THE PAIN CAN BE GONE FOR AS LONG AS SEVERAL YEARS AFTER A NUMBER OF INJECTIONS. PAIN SECONDARY TO REFLEX SYMPATHETIC DYSTROPHY CAN RETURN WITH ANOTHER INCIDENT OF TRAUMA AT THE SITE OF THE SUCCESSFULLY TREATED PAIN.
SOME DRASTIC EXPERIMENTAL TREATMENTS HAVE BEEN TRIED FOR TREATMENT OF CHRONIC REGIONAL PAIN SYNDROME. ONE INVOLVES ADMISSION TO THE HOSPITAL INTENSIVE CARE UNIT AND GIVING VERY LARGE DOSES OF A DRUG CALLED KETAMINE. ENOUGH MEDICATION IS SOMETIMES INFUSED SO THAT THE PATIENT IS IN A COMA. THE MOST DRASTIC OF THESE TREATMENT PROTOCOLS WERE PERFORMED IN GERMANY OR MEXICO BECAUSE THEY WERE NOT APPROVED AS AN EXPERIMENTAL TREATMENT IN THE UNITED STATES.
TREATMENT OF CHRONIC REGIONAL PAIN SYNDROME WITH ACUPUNCTURE HAS BEEN SUCCESSFUL FOR MANY PATIENTS. THE TREATMENT HAS ALLOWED THESE PATIENTS TO HAVE AN IMPROVED QUALITY OF LIFE. TREATMENT OF THIS CONDITION IS SPECIFIC TO EACH INDIVIDUAL PATIENT BECAUSE AT THE BEGINNING OF TREATMENT EVEN THE STIMULATION OF ACUPUNCTURE NEEDLE INSERTION IS PERCEIVED AS VERY PAINFUL.
I HAVE FREQUENTLY BEGUN A TREATMENT SERIES OF A PATIENT WITH CHRONIC REGIONAL PAIN SYNDROME WITH A TREATMENT TECHNIQUE CALLED INVERSE AND CONTRARY. FOR EXAMPLE, TO TREAT A RIGHT ARM OR RIGHT LEG PAIN; NEEDLES ARE PLACED IN THE LEFT ARM AND LEFT LEG WITHOUT INSERTION OF ANY NEEDLES IN THE PAINFUL RIGHT EXTREMITY. THIS SHOWS THE PATIENT THAT ACUPUNCTURE CAN RELIEVE THEIR PAIN AND AS THE CONDITION IMPROVES THEY CAN TOLERATE FURTHER MORE SOPHISTICATED TREATMENT.
CHRONIC REGIONAL PAIN SYNDROME IS NOT A CONDITION THAT CAN BE TREATED WITH A FEW SESSIONS AND BE DONE WITH ACUPUNCTURE. IT SHOULD BE PERFORMED 1-3 TIMES A WEEK INITIALLY AND THEN OFTEN ENOUGH TO KEEP THE SYMPTOM SEVERITY LOW ENOUGH FOR THE PATIENT TO FUNCTION. SOME PATIENTS HAVE BEEN TREATED ONCE OR TWICE A MONTH FOR YEARS. THE TREATMENT COURSE CAN BE PROLONGED BUT THE PATIENTS ALL REALIZE THAT THE ACUPUNCTURE TREATMENTS GIVE THEM MUCH BETTER PAIN RELIEF AND QUALITY OF LIFE THAN ANY OTHER TREATMENT THEY HAVE HAD.
THIS CONDITION HAS BEEN DESCRIBED AS EARLY AS THE CIVIL WAR AS A RESULT OF GUNSHOT WOUNDS OR OTHER TRAUMA. THIS CONDITION USUALLY AFFECTS THE ARMS OR LEGS. IT IS A RESULT OF TRAUMA. CHRONIC REGIONAL PAIN SYNDROME CAN OCCUR AFTER A SEVERE CRUSHING INJURY WITH BROKEN BONES AND INJURED NERVES. A HISTORY OF A SEVERE FORCEFUL TRAUMATIC EVENT IS NOT A NECESSARY CHARACTERISTIC FOR THE DEVELOPMENT OF CHRONIC REGIONAL PAIN SYNDROME. THE INTENSITY OF THE INITIATING TRAUMA CAN APPEAR TO BE VERY SLIGHT. ONE CHARACTERISTIC DIAGNOSTIC PITFALL IS THAT THE PATIENT COMPLAINS OF VERY SEVERE PAIN THAT IS MUCH MORE SEVERE THAN THE CLINICIAN WOULD EXPECT CONSIDERING THE INITIAL INJURING EVENT. BECAUSE OF THIS SEEMINGLY ILLOGICAL DIFFERENCE BETWEEN THE RELATIVELY SMALL INTENSITY OF INJURING FORCE AND THE RESULTING VERY SEVERE PAIN COMPLAINTS, SOMETIMES PATIENTS ARE NOT TAKEN SERIOUSLY AND CHARACTERIZED AS COMPLAINERS RATHER THAN SOMEONE WITH A SEVERE INCAPACITATING PAIN CONDITION. THIS DIAGNOSIS TYPICALLY IS NOT MADE UNTIL AFTER MANY MONTHS OF INEFFECTIVE TREATMENTS.
AS THE CONDITION DEVELOPS THE ARM OR LEG CAN CHANGE COLORS, BECOME COLD, LOSE HAIR, AND GREATLY DIMINISH IN SIZE. IT HURTS SO MUCH FOR THE PATIENT TO MOVE THE ARM OR LEG THAT THEY AVOID ANY MOVEMENT AT ALL THE MUSCLES GET SMALLER. WHEN THE CONDITION REACHES THIS POINT WITH ALL OF THESE SERIOUS SYMPTOMS AND PHYSICAL CHARACTERISTICS, THE DIAGNOSIS IS EASIER TO MAKE BUT THE TREATMENT OF THE CONDITION IS MORE DIFFICULT.
AT THIS TIME THERE IS NO COMPELLING EXPLANATION WHY SOME PATIENTS DEVELOP THIS VERY SEVERE PAIN CONDITION AND OTHERS DO NOT. ONE OF MY PATIENTS CUT HER FINGER SLICING TOMATOES WHILE WORKING ON A FOOD TRUCK. SHE WOULD DEVELOP PAIN THAT WOULD CHANGE HER LIFE AND ONLY BE ALLEVIATED AFTER 2 OPERATIONS, MANY NERVE BLOCKS AND ACUPUNCTURE. A PATIENT WITH THIS CONDITION CAN RESPOND TO A LIGHT GENTLE TOUCH ON THE ARM, A SENSATION THAT COULD NORMALLY BE DESCRIBED AS PLEASANT, AS IF THEY WERE STABBED WITH A LARGE KNIFE.
TREATMENT OPTIONS:
IN THE PAST THIS CONDITION WAS TREATED BY OPERATIONS TO REMOVE PARTS OF THE SYMPATHETIC NERVOUS SYSTEM OR BY AMPUTATING THE PAINFUL ARM OR LEG. EVEN AFTER THESE DRASTIC METHODS THE PAIN CAN RETURN.
PERFORMING INJECTIONS TO DECREASE THE ACTIVITY OF THE SYMPATHETIC NERVOUS SYSTEM CAN ALMOST ALWAYS DECREASE THE PAIN DURING EACH INJECTION AND CAN SUBSTANTIALLY ALLEVIATE THE PAIN WHEN THE INJECTIONS ARE PERFORMED REPEATEDLY. THE PAIN CAN BE GONE FOR AS LONG AS SEVERAL YEARS AFTER A NUMBER OF INJECTIONS. PAIN SECONDARY TO REFLEX SYMPATHETIC DYSTROPHY CAN RETURN WITH ANOTHER INCIDENT OF TRAUMA AT THE SITE OF THE SUCCESSFULLY TREATED PAIN.
SOME DRASTIC EXPERIMENTAL TREATMENTS HAVE BEEN TRIED FOR TREATMENT OF CHRONIC REGIONAL PAIN SYNDROME. ONE INVOLVES ADMISSION TO THE HOSPITAL INTENSIVE CARE UNIT AND GIVING VERY LARGE DOSES OF A DRUG CALLED KETAMINE. ENOUGH MEDICATION IS SOMETIMES INFUSED SO THAT THE PATIENT IS IN A COMA. THE MOST DRASTIC OF THESE TREATMENT PROTOCOLS WERE PERFORMED IN GERMANY OR MEXICO BECAUSE THEY WERE NOT APPROVED AS AN EXPERIMENTAL TREATMENT IN THE UNITED STATES.
TREATMENT OF CHRONIC REGIONAL PAIN SYNDROME WITH ACUPUNCTURE HAS BEEN SUCCESSFUL FOR MANY PATIENTS. THE TREATMENT HAS ALLOWED THESE PATIENTS TO HAVE AN IMPROVED QUALITY OF LIFE. TREATMENT OF THIS CONDITION IS SPECIFIC TO EACH INDIVIDUAL PATIENT BECAUSE AT THE BEGINNING OF TREATMENT EVEN THE STIMULATION OF ACUPUNCTURE NEEDLE INSERTION IS PERCEIVED AS VERY PAINFUL.
I HAVE FREQUENTLY BEGUN A TREATMENT SERIES OF A PATIENT WITH CHRONIC REGIONAL PAIN SYNDROME WITH A TREATMENT TECHNIQUE CALLED INVERSE AND CONTRARY. FOR EXAMPLE, TO TREAT A RIGHT ARM OR RIGHT LEG PAIN; NEEDLES ARE PLACED IN THE LEFT ARM AND LEFT LEG WITHOUT INSERTION OF ANY NEEDLES IN THE PAINFUL RIGHT EXTREMITY. THIS SHOWS THE PATIENT THAT ACUPUNCTURE CAN RELIEVE THEIR PAIN AND AS THE CONDITION IMPROVES THEY CAN TOLERATE FURTHER MORE SOPHISTICATED TREATMENT.
CHRONIC REGIONAL PAIN SYNDROME IS NOT A CONDITION THAT CAN BE TREATED WITH A FEW SESSIONS AND BE DONE WITH ACUPUNCTURE. IT SHOULD BE PERFORMED 1-3 TIMES A WEEK INITIALLY AND THEN OFTEN ENOUGH TO KEEP THE SYMPTOM SEVERITY LOW ENOUGH FOR THE PATIENT TO FUNCTION. SOME PATIENTS HAVE BEEN TREATED ONCE OR TWICE A MONTH FOR YEARS. THE TREATMENT COURSE CAN BE PROLONGED BUT THE PATIENTS ALL REALIZE THAT THE ACUPUNCTURE TREATMENTS GIVE THEM MUCH BETTER PAIN RELIEF AND QUALITY OF LIFE THAN ANY OTHER TREATMENT THEY HAVE HAD.
