Treating Complex Regional Pain Syndrome

You sprained your big left toe weeks ago, but instead of healing, the pain has grown, and now your right foot aches too. What gives? Complex regional pain syndrome is a chronic condition that often affects arms and legs and lasts weeks longer than it should. It can leave patients and doctors perplexed. What is this elusive pain disorder? Doctors explain and share how new treatments can help…

An ankle sprain or broken wrist is uncomfortable and inconvenient, but with proper treatment you can recover completely.

But for some people, even small traumas can lead to a severe and debilitating pain disorder called complex regional pain syndrome (CRPS). The exact cause is unclear, but research suggests it may result from nerve damage after an injury.

It feels like an intense throbbing or burning. Instead of getting better as days go by, the pain grows.

“Pain neurons [at the site of an injury] are only supposed to fire briefly to signal a problem,” says Anne Louise Oaklander, M.D., Ph.D., director of the Nerve Injury Unit at Massachusetts General Hospital in Boston. “But in CRPS, these neurons get short-circuited, causing them to fire continually – resulting in prolonged, debilitating pain.”

CRPS affects as many as 1.2 million Americans, and up to 75% are women, according to the Reflex Sympathetic Dystrophy Syndrome Association, a nonprofit that aims to help educate sufferers, insurance companies and health-care providers. (Reflex Sympathetic Dystrophy Syndrome is another name for CRPS.)

A Mysterious Condition
Because the pain often seems out of balance with the level of harm initially suffered, many patients’ concerns are dismissed.

“A doctor sees someone in agony over a sprained ankle, and it seems so exaggerated and out of proportion to the injury that they have a difficult time believing the pain is real,” explains chronic pain specialist Robert Schwartzman, M.D., chairman of the neurology department at Drexel University College of Medicine in Philadelphia.

In 2006, Oaklander and other Massachusetts General researchers discovered key evidence of a physical abnormality linked to CRPS.

“The skin in the affected area appears to have lost some small nerve-fiber endings,” Oaklander says. “These nerve endings transmit pain messages, control skin color and temperature, and may be involved in other pain disorders – so we believe they may also be linked to CRPS.

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