Understanding and Managing Chronic Regional Pain Syndrome

At Horizon Spine & Pain of Utah, we understand the complexity and challenges of Chronic Regional Pain Syndrome (CRPS). This debilitating condition can severely impact daily living, but with early diagnosis and expert management, many patients can find real relief. Our goal is to provide compassionate, advanced care to help restore your function and quality of life.

Chronic Regional Pain Syndrome (CRPS) is a chronic pain condition usually affecting one limb (arm, leg, hand, or foot) after an injury or surgery. It is characterized by persistent, severe pain, often out of proportion to the initial injury. CRPS is believed to involve abnormal responses from both the peripheral and central nervous systems.

There are two types:

• CRPS-I: Occurs without a confirmed nerve injury.
• CRPS-II: Occurs after a distinct, confirmed nerve injury.

While the exact cause of CRPS is not fully understood, common triggers include:

• Trauma (fractures, sprains, soft tissue injuries)
• Surgery or medical procedures
• Infections
• Nerve injuries
• Immobilization (prolonged casting or bracing)

Abnormal inflammatory responses and dysfunction in the nervous system are key factors contributing to CRPS development.

Certain factors can increase the likelihood of developing CRPS:

• Women are more commonly affected than men
• Ages 20–50 have the highest incidence
• History of migraines, smoking, or autoimmune diseases
• Psychological stress or emotional trauma may exacerbate symptoms

Early identification of symptoms is crucial to minimizing the severity and progression of CRPS.

Symptoms of CRPS often vary but may include:

• Severe, burning, or throbbing pain
• Swelling in the affected limb
• Skin color changes (red, blue, pale)
• Temperature changes (hot or cold sensations)
• Abnormal sweating in the affected area
• Muscle weakness or tremors
• Decreased range of motion or stiffness
• Shiny, thin skin or changes in hair and nail growth

Pain may spread beyond the original injury site and worsen over time if untreated.

At Horizon Spine & Pain of Utah, we use a comprehensive approach to diagnose CRPS:

• Detailed medical history and symptom review
• Physical examination, focusing on sensory, motor, and autonomic function
• Diagnostic imaging (such as MRI or bone scans) to rule out other conditions
• Sympathetic nerve blocks as both a diagnostic and therapeutic tool

CRPS is primarily a clinical diagnosis, meaning it is based on symptom patterns and physical findings rather than one definitive test.

Early and aggressive treatment greatly improves outcomes. Non-surgical therapies for CRPS include:

Medications:

• Anti-inflammatory drugs (NSAIDs)
• Neuropathic pain medications (gabapentin, pregabalin)
• Antidepressants for nerve pain (amitriptyline, duloxetine)
• Bisphosphonates or corticosteroids in some cases

Physical and occupational therapy:

• Essential to maintain joint movement, muscle strength, and function

Psychological therapy:

• Cognitive Behavioral Therapy (CBT) can help manage the emotional impact of chronic pain

Multidisciplinary care combining physical and emotional therapies is often most successful.

For more challenging cases, we offer advanced interventional options:

• Sympathetic nerve blocks:
  • Target the sympathetic nervous system to reduce pain and inflammation
• Spinal cord stimulation (SCS):
  • An implantable device that disrupts pain signals traveling to the brain
• Peripheral nerve blocks:
  • For localized symptom relief
• Ketamine Infusions:
  • Help relieve CRPS by blocking NMDA receptors, which play a key role in amplifying chronic neuropathic pain

Advanced therapies can provide long-term relief and restore function for patients not responding to conservative care.

Surgical intervention for CRPS is rare but may include:

• Implantation of neuromodulation devices (such as spinal cord stimulators)
• Sympathectomy (surgical interruption of the sympathetic nerves), though it is rarely recommended today due to variable outcomes

At Horizon Spine & Pain of Utah, we pursue surgery only after exhausting non-surgical and less invasive treatments.

At Horizon Spine & Pain of Utah, we provide:

• Board-certified pain management specialists experienced in treating complex conditions like CRPS
• Comprehensive diagnostic and treatment plans tailored to your unique needs
• Minimally invasive and advanced interventional therapies
• Collaborative care with physical therapists and psychologists

Our mission is not only to control your pain but to empower you to regain function and independence.