Complex Regional Pain Syndrome: An Often Misunderstood Chronic Condition
Symptoms and Diagnosis
CRPS typically presents with four main categories of symptoms:
Pain - Severe burning pain that is persistent and disproportionate to any inciting event. The pain is typically constant and can be triggered by trivial events such as touch or air movement.
Sensory Changes - Hypersensitivity to normally non-painful stimuli such as light touch, temperature changes, or pressure. Patients may feel as if their skin is crawling.
Swelling and Skin Changes - Swelling, temperature changes, or skin color and texture changes in the affected area. Skin may appear shiny, feel warm or cool, or change color from blotchy red, blue, or pale.
Motor/Trophic Changes - Limited range of motion, weakness, tremor, or muscle spasms. Changes to nails, hair growth, or sweating may also occur.
A diagnosis of Complex Regional Pain Syndrome is made clinically based on findings on physical examination and symptom criteria established by the International Association for the Study of Pain. There are no specific diagnostic tests for CRPS, and other conditions must be excluded to confirm the diagnosis. Radiography, thermography, and bone scans may help detect changes to support the diagnosis but are not usually definitive on their own.
Differential diagnosis
Given the difficulty of diagnosing CRPS, it is important to rule out other conditions that may better explain a patient’s signs and symptoms. Potential differential diagnoses include:
- Phantom Limb Pain - For amputees, CRPS sometimes develops in the remaining limb or at the site of amputation.
- Neuropathies - Other neuropathic pain conditions affecting nerves.
- Arthritis - Inflammatory or degenerative joint diseases.
- Tendinitis/Bursitis - Inflammation of tendons or bursa.
- Lymphedema - Fluid build-up causing swelling.
- Vasculitis - Inflammation of blood vessels.
Obtaining the patient history, conducting a thorough exam, and considering diagnostic testing can help properly differentiate CRPS from other conditions. An experienced provider is key to making the correct diagnosis of CRPS and ruling out alternative causes.
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