Sudeck’s disease, also called complex regional pain syndrome, CRPS I, is a rare form of chronic pain that usually affects one arm or leg. Sudeck’s disease typically develops after injury, surgery, stroke, or a heart attack, and the pain is out of proportion to the severity of the initial cause of the disease.
What is Sudeck’s disease?
‘Sudeck’s disease is characterized by continuous burning and throbbing pain, usually in the arm, leg, hand or foot. The characteristics of Sudeck’s disease may change over time and vary from person to person. Sensitivity to touch or cold, swelling of the painful area, changes in skin temperature and color are just a few symptoms of Sudeck’s disease. If changes in hair and nail growth, joint stiffness, muscle spasms, and decreased range of motion of the affected body part occur, the condition is often irreversible. Sudeck’s disease can be aggravated by emotional stress. In the case of constant severe pain that affects only the limbs and seems unbearable, a doctor should be consulted, as the chances of recovery from Sudeck’s disease increase with timely diagnosis.
Causes
Sudeck’s disease is thought to be caused due to an impaired interaction between the nervous system and inappropriate inflammatory responses. Sudeck’s disease occurs in two types with similar signs and symptoms but with different causes. Sudeck’s disease type-1 was formerly known as sympathetic reflex dystrophy syndrome and occurs after an illness or injury that did not, however, directly damage the nerves of the affected limb. This type includes more than 90 percent of all cases of the disease. Sudeck’s disease type-2 (causalgia) involves direct injury to the nerves. Many cases of Sudeck’s disease occur after severe trauma, such as crush injuries, fractures, or amputations. Other injuries resulting from surgical procedures, heart attacks, infections, and even sprained ankles can also trigger the condition.
Symptoms, complaints, and signs
Sudeck’s disease is usually noticeable in the early stages by inflammatory changes near the original injured area. The typical signs of inflammation – redness, swelling, and hyperthermia – are accompanied by functional limitations and pain, which can be excessive. As the disease progresses, the intensity of the pain progressively decreases, and often affected individuals are completely pain-free. The skin is initially pale and cool, later it appears remarkably thin. Connective tissue and muscles shrink significantly, and the affected joints stiffen: In the worst case, they become completely nonfunctional. The disease equally affects sensory, motor and autonomic nervous systems. Sensory disturbances are manifested by insensations and disturbed body perception in the area of the affected extremity. Pain can occur both at rest and under stress and is often triggered by even the smallest stimuli such as a light touch. The mobility of the affected joints is massively limited, and finger involvement is accompanied by loss of fine motor skills. Due to pain and muscle atrophy, the affected body region can only bear limited loads, and movements can be performed with less force. Damage to the autonomic nervous system results in altered skin circulation and thus a change in skin temperature and color. Edema often forms on the affected areas of the body, and the growth of hair and nails may be disturbed.
Diagnosis and course
Diagnosis of Sudeck’s disease is made by taking a history of medical treatments and performing a physical examination. Bone scanning can be used to diagnose bone changes associated with Sudeck’s disease. This involves injecting a radioactive substance into a vein, which allows the bones to be viewed with a special camera. Sympathetic nervous system testing involves thermography of skin temperature to examine blood flow to the limbs or determining the amount of sweat secreted. Aberrant results may suggest Sudeck’s disease. A magnetic resonance imaging (MRI) scan may also document tissue changes.A good preparation for the medical history for the diagnosis of Sudeck’s disease is advisable. For this purpose, all symptoms should be precisely localized, noting their severity, and documented, indicating their duration as well as intervals.
Complications
Primarily, patients suffer from chronic pain due to Sudeck’s disease. In the worst case, this can also lead to a stroke or a heart attack, which can also be fatal for the patient. The life expectancy of the affected person is significantly limited and reduced due to Sudeck’s disease. It is not uncommon for patients to suffer from swelling or reddening of the skin. Furthermore, itching may also occur on the skin. The extremities of those affected are not infrequently warm, and tremors may also be noticeable. Muscle cramps can also occur, which are relatively painful. Likewise, patients not infrequently suffer from paralysis and disturbances in sensitivity, which can occur in different areas of the body. Furthermore, pain at night can also lead to significant sleep problems and thus to irritability of the patient. The quality of life is significantly limited and reduced due to the disease. The treatment of Sudeck’s disease is usually causal and depends on the underlying disease. Furthermore, patients are often dependent on taking painkillers. Whether this results in a reduction in life expectancy cannot generally be predicted.
When should you see a doctor?
A doctor should be consulted if, after an injury, there is severe pain over a long period of time that goes far beyond what is usual for the injury. Arms or legs are usually affected, but in rare cases Sudeck’s disease can develop in other areas of the body. Sensory disturbances such as burning of the skin, tingling or hypersensitivity to touch should also be presented to a doctor. Movement disorders such as muscle twitching, muscle weakness, tremors or limited mobility of the affected body part must also be considered as Sudeck’s disease requiring treatment. Other symptoms that should prompt a visit to the doctor are water retention and profuse sweating in the affected areas – especially if they feel significantly colder or warmer than other areas of the body. Alarm signs can also be accelerated growth of hair and nails in the affected area. The first person to contact if Sudeck’s disease is suspected should be the family doctor. Since the disease cannot always be diagnosed without doubt right away, referrals to specialists in neurology and orthopedics are often made for further clarification. In cases of severe pain, consultation with a pain physician is advisable; in severe cases, inpatient treatment may be required. Psychotherapeutic support is also recommended.
Treatment and therapy
If treatment of Sudeck’s disease begins early, improvement or remission is possible. An individual combination of different therapies is often necessary. To treat the symptoms of Sudeck’s disease, taking medications is helpful in addition to therapies. If simple painkillers no longer relieve the pain, the use of opioid painkillers may be advisable. In addition to thermal applications, various creams are used to reduce hypersensitivity in Sudeck’s disease. Physical therapy is used to reduce pain and promote mobility. Chronic pain can be relieved by applying electrical impulses to the nerve endings (transcutaneous electrical nerve stimulation) or spinal cord stimulation. If treatment is started too late, patients often have to adjust to living with Sudeck’s disease, which can place severe stress on the entire living environment. To cope with life better, relaxation techniques such as biofeedback help sufferers develop better body awareness and relax more easily. The pain caused by Sudeck’s disease can increasingly put a strain on mental health, and here the guidance of a therapist is recommended.
Outlook and prognosis
The prognosis for Sudeck’s disease depends largely on how the affected person deals with the pain condition.Thus, it has been shown that a positive or optimistic attitude regarding the curability of the condition significantly improves the prognosis, while a preoccupation with the worst consequences leads to a worsening. It is worth knowing that in more than 80 percent of those affected, thanks to good and diversified therapy, a condition is achieved that can no longer even be diagnosed as Sudeck’s disease. However, the majority of patients still experience pain, but not movement disabilities. Multimodal treatment can lead to good success within months in complex regional pain syndrome. It is crucial to maintain the patient’s will not to be controlled by the often unexplainable disease. The ability to move the affected region of the body should be maintained. At the same time, painkillers are sometimes used and, thanks to psychotherapy, the patient learns measures to help him cope with the condition. The therapy can sometimes take years. A chronic and severe course that leaves those affected by Sudeck’s disease with a disability is possible. In such cases, there is then a loss of function of the affected body part and therapies are no longer sufficient to restore function.
Prevention
Various studies have shown that the risk of Sudeck’s disease can be reduced. After a wrist fracture, daily use of vitamin C supplements can reduce the risk of disease. Early mobilization after a stroke may also reduce the risk of Sudeck’s disease. Optimal pain management involves a combination of centrally and peripherally acting methods. Invasive pain pumps offer a high degree of autonomy, carry almost no potential for addiction, and facilitate the daily lives of those affected. This reduces psychological stress and minimizes pain perception. However, sufferers must first learn to use them. Non-drug pain therapies also increase well-being, counteract relieving postures and contractures, and provide relaxation. These include cold and heat applications, massages, TENS, gentle positioning, relaxation exercises or aromatherapy.
Aftercare
In most cases, aftercare is aimed at affected persons and their relatives. This is because only with the help of combined therapy can sufferers cope better with their pain, verbalize their fears, and thus receive tolerance from those around them. Aftercare can include physical therapy, for example, in which pain-adapted methods of coping with work or mobility are learned. Psychological therapies also help patients cope with pain and practice healthy behavior while integrating pain. Additional therapies such as music, dance, art, or autogenic training help chronic pain patients relax and reduce stress, which results in a decreased perception of pain. In an occupational therapy practice, patients learn how to use aids in everyday life to make life easier. Physical therapies support lymphatic drainage and prevent lymphatic congestion, which can otherwise lead to increased pain and reduced mobility.
Here’s what you can do yourself
If Sudeck’s disease is detected early, symptoms can be relieved with drug treatment. The patient can support medical therapy by taking natural pain relievers. Naturopathy offers effective preparations, such as St. John’s wort capsules or teas made from African devil’s claw. In addition, various creams are used to alleviate hypersensitivity. The pain can be reduced by targeted massages. Mobility can also be alleviated by pressure massages and acupuncture. In consultation with the doctor, methods from Chinese medicine can also be used to dull the discomfort. Chronic pain can be relieved with relaxation techniques. Attacks often subside with calm inhalation and exhalation and the use of essential oils. Since Sudeck’s disease can also affect mental health, the guidance of a therapist is always recommended. The patient should also consult closely with the responsible medical professional, especially if the course is severe or the general prognosis is poor. People in whom Sudeck’s disease is already far advanced must in any case be treated in a specialist clinic.
