Diagnosis | CRPS (Complex Regional Pain Syndrome)

Diagnosis

The diagnosis of CRPS is relatively complicated because there is no simple test procedure, causes are still largely unknown and it can develop very differently in different patients. Therefore, the diagnosis is usually based on the patient’s medical history and symptoms. In addition, procedures such as magnetic resonance imaging (MRI) and X-rays to assess joints and soft tissue, or a measurement of skin temperature are also possible.

Therapy

The treatment of this pain syndrome is also not easy, usually very lengthy and not even then in all cases promising success. The earlier the disease is diagnosed and a therapy is started, the better the chances are for a patient to become symptom-free again. Fortunately, a chronification, i.e. a permanently existing disease rarely develops.

It is important to include different approaches in the therapy. Pain therapy is, of course, in the foreground. Here, anti-inflammatory painkillers such as ibuprofen or diclofenac are used.

Cortisone or antidepressants can also be used. These are particularly effective for pain originating from the nerves themselves. Furthermore, ointments such as dimethyl sulfoxide ointment can be used as a supporting measure.

This has an anti-inflammatory and pain-relieving effect and should have a positive influence on water retention. While in the acute stage, immobilisation and elevation of the affected limb is more likely to help, subsequent physiotherapeutic treatment is very important to prevent functional limitations in the affected area. The subsequent muscle reconstruction is also very important to ensure the stability and mobility of a joint.

This can also be supported and guided by physiotherapy. Vitamin D and calcium preparations can also be used to protect the bone. The psychological support of the affected person should certainly not be underestimated, as depression, anxiety and reduced self-esteem can often play a role in the chronification of the disease.

This also includes behavioural therapies and relaxation therapies. The goal of occupational therapy is to make everyday life easier for the patient, thus the quality of life is extremely increased. Various exercises and aids are used here.

An important method of occupational therapy is active movement therapy. Here, the function of muscles, tendons and ligaments is promoted and maintained through active movement of the musculature. It is important to maintain the normal range of motion and to prevent incorrect posture and thus tension and damage to the musculoskeletal system.

In turn, this makes it easier to be independent in everyday life. Another point is to learn movement sequences and methods that make everyday tasks easier. The correct handling of aids such as thickened grips, shoehorns and the like is also practiced here.

With limited mobility and lack of strength, everyday tasks such as tying shoes or opening bottles can be difficult. Occupational therapy helps the patient to cope better with such everyday tasks. Sometimes dynamic splints can also be used to relieve a joint, allowing earlier mobilisation.

Heat or cold applications are not suitable for CRPS therapy. Especially in the case of CRPS in the hand or arm, a nerve blockage can help to relieve pain. These procedures are used when other measures such as medication and physiotherapy have not been able to relieve the pain.

Here, there is the possibility of injecting an opioid, a very strong painkiller, into the immediate vicinity of a nerve or a collection of nerve cells, a so-called ganglion. The ganglia are, so to speak, switching stations of the pain conduction. In this way the transmission of pain is interrupted.

There is also the possibility of “switching off” the nerve plexus responsible for the arm, the so-called brachial plexus, or individual nerves with this method. Another possibility to relieve the pain is nerve stimulation. This can be done either through the skin or at the spinal cord.

In this case, electrodes are used to apply a current stimulus, which should prevent the information of the pain from being transmitted to the brain via the nerves. When stimulating the spinal cord, electrodes are placed through a small incision in the skin on the meninges of the spinal cord and apply light current pulses. The electrodes can remain there for several years.

In nerve stimulation through the skin (transcutaneous nerve stimulation), the electrodes are placed on the skin of the painful area. By means of different current impulses, on the one hand endorphins are released which help to relieve the pain, on the other hand pain-conducting nerves are blocked. Lymphatic drainage is used to prevent unpleasant swellings.

Lymph drainage is about distributing the accumulated lymph fluid in the lymph vessels in order to improve lymph drainage. The pumping system of the lymph is stimulated by various special grip techniques, which look like a massage to the layman. This is because the different pressure on the lymph vessels irritates the tissue and stimulates the muscle cells of the lymph vessels to contract and to pump at a higher frequency. In the process, the lymph drainage is moved in the direction of the discharging large lymph vessels and lymphatic trunks. In addition to the effect of promoting lymph drainage, lymphatic drainage also has analgesic, calming, stomach tract stimulating and tonus-lowering effects with regard to the skeletal muscles.