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What is Complex Regional Pain Syndrome?

Complex regional pain syndrome (CRPS) is a multifaceted disabling pain condition that develops as a disproportionate response to extremity trauma. According to the National Institute of Neurological Disorders and Stroke, as explained by Lohnberg and Altmaier (2013), “ pain is experienced in excess of what one would expect given the injury that occurred and most often affects an extremity such as an arm, hand, leg or foot” (p.247).

Etiology

The majority of cases of CRPS occur after a forceful trauma to an arm, hand, leg or foot, such as a fracture, crash injury or amputation. Fractures are the most commonly reported precipitating event, and the upper extremity is more frequently involved than the lower (www.mayoclinic.org).

Additionally, three pathophysiological concepts have been identified for the development of CRPS: inflammatory disease, autonomic dysfunction and central nervous system disease (Maihofner, Seifert & Markovic, 2010).

Common Symptoms

CRPS presents a variety of different symptoms, including:

· Pain and sensory dysfunction

· Sensitivity to touch or cold

· Inflammation

· Changes in skin temperature, texture and/or color

· Changes in hair and nail growth

· Joint stiffness, swelling and damage

· Muscle spasms, weakness and/or atrophy

· Decreased ability to moved the affected extremity

Though these are the common signs and symptoms of CRPS, each case must be evaluated on an individual basis.

Prognosis

Similar to the presentation of symptoms, the prognosis of complex regional pain syndrome varies by individual experience. However, children and teenagers most often endure good recoveries. In some cases, symptoms of CRPS dissipate on their own, while others may persist for months or years. Individuals with CRPS are occasionally left with unremitting pain and irreversible changes despite treatment, though evidence suggests that early intervention, particularly rehabilitation, is helpful in limiting the disorder (www.ninds.nih.gov).

Common Treatment Options

Treatment of CRPS includes multiple modalities. Although treatment plans must be evaluated and tailored on an individual basis, a combination of therapies is typically necessary.

Non-pharmacological treatments of CRPS include:

· Physical therapy

· Occupational therapy

· Vocational rehabilitation

· Transcutaneous Electrical Nerve Stimulation (TENS)

· Spinal cord stimulator

Pharmacological treatments of CRPS include:

· Non-steroid anti-inflammatory drugs (most common)

· Glucococrticoids

· Calcitonin

· Bisphosphonates

· Gabapentin

· Opiods

· Baclofen

Functional Limitations

Functional limitations affected by CRPS include:

· Mobility

· Strength

· Range of motion

· Stamina

· Activities of daily living

· Recreational abilities

· Self-care

· Employability

· Mood

· Attention/concentration

Psychosocial Impact

CRPS has a widespread psychosocial impact on an individual’s life, affecting his or her vocational capabilities, recreational activities, family and social life, emotional well-being and overall quality of life

From a vocational perspective, extremity impairments, functional limitations and chronic pain associated with CRPS significantly negatively impact an individual’s employability. Job loss may occur for a variety of reasons, include absenteeism, reduced productivity and/or functional inability to perform job demands. Furthermore, as the severity of symptoms increase, the chances of job loss and long-term unemployment increase (Aronoff, et al., 2002).

CRPS can also effect an individual’s personal life, including their ability to perform recreational activities and activities of daily living, as well as their mood, social and family life.

Potential Accommodations or Assistive Technology

According to information contained within the Effective Accommodation Practices (EAP) Series provided by the Job Accommodation Network (2011), possible job accommodations for individuals with CRPS pertain to activities of daily living, depression and anxiety, fatigue/weakness and muscle pain and stiffness.

Activities of Daily Living:

· Allow use of a personal attendant at work

· Allow use of a service animal at work

· Make sure the facility is accessible

· Move workstation closer to the restroom

· Allow longer breaks

· Refer to appropriate community services

· Provide access to a refrigerator

Depression and Anxiety:

· Develop strategies to deal with work problems before they arise

· Provide sensitivity training to coworkers

· Allow telephone calls during work hours to doctors and others for support

· Provide information on counseling and employee assistance programs

· Allow time off for medical treatment

Fatigue/Weakness:

· Reduce or eliminate physical exertion and workplace stress

· Schedule periodic rest breaks away from the workstation

· Allow a flexible work schedule and flexible use of leave time

· Allow a self-paced workload

· Provide parking close to the work-site and an accessible entrance

· Install automatic door openers

· Provide an accessible route of travel to other work areas used by the employee

· Move workstation close to other work areas, office equipment, and break rooms

Muscle Pain and Stiffness:

· Implement ergonomic workstation design, i.e., ergonomic chair and adjustable workstation to alternate between sitting and standing

· Reduce repetitive tasks or interrupt the tasks with other duties

· Provide carts and lifting aids

· Modify work-site temperature and/or dress code

· Use fan/air-conditioner or heater at the workstation

· Allow work from home during extremely hot or cold weather

Resources for Individuals with CRPS

· National Institute of Neurological Disorders and Stroke (www.ninds.nih.gov)

· American RSD Hope (www.rsdhope.org)

· Reflex Sympathetic Dystrophy Syndrome Association of America (www.rsds.org)

· CRPS/RSD: A Better Life Blog (http://crps-rsd-a-better-life.blogspot.com)

· NeuroTalk Communities: RSD and CRPS (http://neurotalk.psychcentral.com/forum21.html)