Complex Regional Pain Syndrome was first described by Ambroise Pare who reported that after blood-letting King Charles IX, who had persistent pain. This fits into what can trigger the disorder: burns, cuts, surgical procedures, sprains. In the past CRPS was linked with the word causalgia which depicts a burning sensation.
About 1 in 3,800 people a year are diagnosed with CRPS and 7% of people who experience in one limb will later experience it in another limb.
It is pain that is usually severe and debilitating and it is mostly triggered a month after a serious injury. The pain that continues lasts long after that injury has healed. The pained area can be provoked by the slightest touch and sensations include high temperature, stiffness, changes in colour in the affected area and even swelling. This chronic pain is categorised into hyperalgesia which is pain caused by pressure or temperature even if the changes in either are only slightly detectable and allodynia which is pain caused by a light stroke of the skin of the affected area.
From this, I would think that maybe if the nerves were damaged before by an injury that the damage to these cells in some way influences how we feel/ perceive pain after the original injury is long gone. I would also wonder why whatever caused the pain then subsides to some degree overtime. What is switching the pain on and off? Why does the pain ‘spread’ to another limb in 7% of cases?
I now know that the pain is most likely caused by the body reacting abnormally to a former injury and because not everyone who goes through an injury suffers from CRPS, actually it is very rare; it is probably not caused by one single factor but many different ones.
This strange reaction causes a knock- on effect in several systems like the central nervous system and the system of nerves that lie outside of the central nervous system (the peripheral nervous system), the immune system and blood vessels. This then affects how our body responds to and transmits pain signals, swelling, temperature and movement, explaining why the slightest touch can cause intense pain; the signals aren’t functioning ‘properly’. Maybe this is why the pain ‘spreads’ because whatever is wrong with the systems in the body doesn’t fix itself and therefore the problems begin to affect other parts of the body.
I now know that it isn’t the pain that is being switched on and off but the systems in the body that control how we handle pain that cause the disorder. I still don’t understand why this pain eventually subsides a little bit unless the body somehow adapts to the pain and researchers haven’t published an understanding on this either.
Diagnosing CRPS is a lengthy process because first other things must be eliminated because it is so rare. The patients goes through blood tests to rule out infection, an MRI eliminating tissue and bones issues and X-rays ruling out joints and bones and other tests rule out nerve problems. Maybe because of the complexity of the disorder, there is no direct treatment but people with CRPS are encouraged to keep up physical activity, sometimes given pain management medication -(first painkillers, then anticonvulsants and antidepressants that can treat nerve pain, then spinal cord stimulation which can change the way that we feel pain)- but I think that the most important treatment is the psychological side of things as the strain on your psyche must be tremendous- feeling pain when you know that there is no ‘real’ injury.
I’d imagine that CRPS must make everyone feel quite helpless: the patients, doctors have nothing really that can be done to relieve the pain, there is only a certain amount of relief drugs can provide if any and even the best physical rehabilitation doesn’t make the pain any less bearable. After a while, the pain of most people lessens but this is something that they have no control over.
What are your suggestions on what causes the unexplained symptoms and developments of CRPS? Let me know in the comments as well as any suggestions for upcoming posts.
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