The diagnosis and management of Complex Regional Pain Syndrome, formerly known as Reflex Sympathetic Dystrophy has always been a controversial issue. However, the Social Security Administration’s ruling in the Federal Register on October 20, 2003 provides helpful diagnostic guidelines. There is, however, still no consensus on how to appropriately treat CRPS.

CRPS is diagnosed by documenting a history of injury in any part of the body, especially the limbs, followed by complaints of severe pain, skin sensitivity, swelling and reddish purple discoloration, sweating, hair loss or growth, atrophy, and warmth in the acute setting but cold in the chronic setting. Contrary to popular belief CRPS can spread to any part of the body, including internal organs and can also affect hormone regulation.

CRPS is classified into Type I and Type II. The clinical features are basically the same in both categories. The only difference is that no specific nerve injury can be identified in Type I, whereas in Type II, nerve injury can be documented. In addition to obtaining a good history and physical examination, some useful diagnostic tools include thermography, bone scan, quantitative sensory testing and sweat output measurement.

Although there is no known cure for this disease, it can be controlled if treated within three months of actual onset, not diagnosis. We have more than seven years of experience in the diagnosis and management of CRPS using a multi-disciplinary, non surgical approach with the proper combination of medications, nerve blocks, massage, and physical and occupational therapy. Our protocol has been most effective in reducing pain and suffering, thereby improving quality of life and activities of daily living.

We do not recommend surgery for the management of CRPS unless there is a critical or life threatening problem. The pain of CRPS can mimic symptoms of carpal tunnel syndrome, ulnar neuropathy and disk herniation, and it is wrong to operate in such cases. Ganglion blocks may be helpful if given within three months of disease onset, but not in chronic cases. In our experience, no patient referred to us has ever benefitted from the use of a spinal cord stimulator.

Conventional opiates such as Oxycontin, Dilaudid, Lorcet, Lortab, MS Contin are excellent analgesics in the acute setting but have limited value in chronic cases due to their long term side effects. Antagonist opiate analgesics such as Buprenex or Nubain are better alternatives because of their lesser addicting properties. We have found that antidepressants such as Trazodone and Effexor XR, muscle relaxants like Klonopin and Zanaflex, anticonvulsants like Trileptal and Neurontin, and anti-inflammatories like Mobic, when used in the appropriate circumstances, are helpful in reducing the symptoms and signs of CRPS

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