Definition
The abbreviation CRPS stands for “Complex Regional Pain Syndrome”, which means “complex regional pain syndrome”. This disease is also known as Sudeck’s disease (named after its discoverer Paul Sudeck), algo- or (sympathetic) reflex dystrophy. CRPS occurs particularly often on the limbs, mostly on the arms or hands. Women are slightly more frequently affected than men. CRPS is a chronic neurological disease characterized by strong localized pain and later a decrease (atrophy) of muscle tissue in the affected limb.
Cause
How the clinical picture of CRPS develops has not yet been conclusively clarified. The most frequent triggers are injuries, for example fracture of the forearm (radius fracture). However, an inflammation or an operation can also be the cause of CRPS.
Sometimes the causal injury is so minor that the affected person cannot remember it. The extent of the pain syndrome is not directly related to the extent of the injury. In CRPS, the healing process of the tissue is disturbed following the injury.
It is assumed that this is related to an inflammatory reaction. There is probably an overproduction of inflammatory mediators that are not broken down by the body quickly enough. This prolongs the inflammation and leads to a sensitisation of the nerves responsible for the sensation of pain. Various processes in the brain and spinal cord lead to an increased perception of pain.
Types
There are two different types of CRPS. Type I: Type I of CRPS was formerly also called Sudeck’s disease. In this disease the typical clinical symptoms and complaints occur without any obvious damage to nerves.
Approximately 90 % of all CRPS cases belong to type I. Type II: In type II, nerves in the injured body region are demonstrably damaged due to a fracture or trauma of limbs. Since there is a cause associated with the symptoms, Type II is also called the causal type (causalgia). The symptoms can spread beyond the actual supply area of the affected nerves.
Stadiums
The disease can be divided into different stages, which describe the rough course of the disease. However, it is difficult to make a strict distinction in everyday life, as there is often an overlap. Overall, the course of the disease varies greatly from person to person.
Stage I: Stage I is also called the inflammatory stage. It involves severe, burning pain at rest and inflammatory swelling in the affected area. In addition, there is increased blood circulation, changes in skin colour and skin temperature and hypersensitivity to touch.
Increased sweating and water retention can also be observed at this stage. This stage lasts up to 3 months. Stage II: Characteristics of stage II are further spreading, increasing or even decreasing pain, beginning stiffening of the joints as well as osteoporosis (decalcification and susceptibility to fracture of bones).
There is also a decrease in muscle mass (muscle atrophy) and changes in skin and nails (e.g. cold, pale skin). Stage III: In stage III, the pain is no longer limited to one area, but is diffuse. In some patients it may even have disappeared completely.
Typical signs are restricted movement and loss of function of the affected extremity (arms or legs), significant muscle and tissue loss and thin, shiny skin. Due to the increasing decrease in mobility and function, this stage is also called atrophic, degenerative stage. The main focus of CRPS is pain, which is usually described as burning.
Touch sensitivity in the affected area is also typical. In the course of the disease it can lead to various other complaints. In the beginning the disease is characterized by inflammation.
In addition to the pain, water retention and circulatory problems occur. These lead to swellings, muscle cramps and a bluish-violet discoloration of the skin. In addition, increased sweating and reduced mobility can occur.
Some people experience spontaneous healing, while for others the symptoms tend to increase. If healing does not occur, the pain usually spreads further, the water retention becomes increasingly hard and growth disorders of the skin and nails can occur. There is also the destruction of muscle and bone tissue and an increasing restriction of movement.
Approximately 6 months after the onset of the symptoms, the last phase of the disease can then occur. Here the tissue loss increases and is no longer reversible. The water retention and pain spreads further. Skin and bones thin out and a loss of function of the limb may occur. In rare cases, blood pressure fluctuations and a disturbance of the immune system can also occur.
