Complex regional pain syndrome history and symptoms
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
The key symptom of complex regional pain syndrome is intense and burning pain, which is much stronger than would be expected for the type of injury that occurred. The pain is also noted to get worse over time. Other symptoms include changes in the skin, hair, or nails. As the disease progresses, there is more edema, and irreversible changes occur in the skin and bones.
History
In most cases, CRPS has three stages. However, CRPS does not always follow this pattern. Some people develop severe symptoms almost right away. Others stay in the first stage.
Stage 1 (lasts 1 - 3 months):
- Changes in skin temperature, switching between warm or cold
- Faster growth of nails and hair
- Muscle spasms and joint pain
- Severe burning, aching pain that worsens with the slightest touch or breeze
- Skin that slowly becomes blotchy, purple, pale, or red; thin and shiny; swollen; more sweaty
Stage 2 (lasts 3 - 6 months):
- Continued changes in the skin
- Nails that are cracked and break more easily
- Pain that is becoming worse
- Slower hair growth
- Stiff joints and weak muscles
Stage 3 (irreversible changes can be seen)
- Limited movement in limb because of tightened muscles and tendons (contracture)
- Muscle wasting
- Pain in the entire limb
Symptoms
The key symptom is pain that:
- Is intense and burning, and is much stronger than would be expected for the type of injury that occurred
- Gets worse, rather than better over time
- Begins at the point of injury, but often spreads to the whole limb, or to the arm or leg on the opposite side of the body
If pain and other symptoms are severe or long-lasting, many people may experience depression or anxiety.
The symptoms of CRPS usually manifest near the site of an injury, either major or minor, and usually spread beyond the original area. Symptoms may spread to involve the entire limb and, rarely, the opposite limb. The most common symptom is burning pain. The patient may also experience muscle spasms, local swelling, increased sweating, softening of bones, joint tenderness or stiffness, restricted or painful movement, and changes in the nails and skin.
The pain of CRPS is continuous and may be heightened by emotional stress. Moving or touching the limb is often intolerable. Eventually the joints become stiff from disuse, and the skin, muscles, and bone atrophy. The symptoms of CRPS vary in severity and duration. There are three variants of CRPS, previously thought of as stages. It is now believed that patients with CRPS do not progress through these stages sequentially and/or that these stages are not time-limited. Instead, patients are likely to have one of the three following types of disease progression:
- Type one (RSD) is characterized by severe, weather sensitive, burning pain at the site of the injury. Muscle spasm, joint stiffness, restricted mobility, rapid hair and nail growth, and vasospasm (a constriction of the blood vessels) that affects color and temperature of the skin can also occur.
- Type two (RSD)is characterized by more edema. Swelling spreads, hair growth diminishes, nails become cracked, brittle, grooved, and spotty, and contracture (loss of range of motion) occurs. Joints can thicken and muscles atrophy.
- Type three is characterized by irreversible changes in the skin and bones (osteoporosis). While bone changes can spread, they are most predominant at the injury site. With time the pain can spread to involve the entire limb or other limbs (so called stage four). Most often with stage thee RSD there is marked muscle atrophy, severely limited mobility of the affected area,and flexor tendon contractions (contractions of the muscles and tendons that flex the joints)however not all cases of RSD progress classically from stage (or type) one through three. Occasionally the limb is displaced from its normal position, and marked bone softening is more dispersed