CRPS Awareness Month

Across the globe November is celebrated as CRPS Awareness Month. It is one of the most challenging chronic pain conditions and falls into the category of rare illnesses. Chronic pain is a global public health challenge, becoming an area of great concern to Healthcare professionals, patients, families, and the wider society.

The estimated overall incidence rate of CRPS is 26.2 per 100,000 person years. Females are affected at least three times more often than males (ratio 3:1). The highest incidence occurred in females in the age category of 41-50 years. The upper extremity is affected more frequently than the lower extremity and a fracture is the most common precipitating event (44%). (Source)

However, these findings must be interpreted with caution as there is a severe lack of epidemiological data on the prevalence of a rare, complex, and severe chronic pain condition like Complex Regional Pain Syndrome (CRPS) in India due to the lack of awareness, knowledge, and enormous stigma that Chronic illnesses carry.

What is CRPS?

Complex regional pain syndrome (CRPS) previously known as reflex sympathetic dystrophy is a chronic neurological disorder involving the limbs characterized by disabling pain, swelling, vasomotor instability, sudomotor abnormality, and impairment of motor function. (Source)

The first case of CRPS can be traced back to the Second World War when it was noticed in the war soldiers. As a condition, Complex Regional Pain Syndrome (CRPS) is like a notorious monster that has a debilitating impact on not just the physical state of the individual, but also impacts the psychological and social state of the individual beyond repair. The exact cause of CRPS is unclear, however, it is generally believed to be a result of the body’s response to an external injury.

Symptoms of CRPS

It is interesting to note that each individual suffering from CRPS experiences various combinations and intensity of the symptoms. Presently the Budapest Criteria proposed by Harden et al (2010) is utilised as a standard Diagnostic Criteria for CRPS. According to the Budapest criteria, patients often experience clinical symptoms in four categories comprising of:

• Sensory Disturbances: Excruciating Pain is one of the most prominent symptoms of CRPS. The pain experienced by the individual is often described as out of proportion to

the initial injury, stabbing, burning, shooting, and persistent. Amongst Sensory disturbances, Mechanical Hyperalgesia or heightened pain response from a stimulus that induces pain or Allodynia or heightened pain response from a stimulus does not normally induces pain, is commonly observed.

• Vasomotor Disturbances: This includes skin looking reddish or bluish in severe cases, changes in skin texture of the affected part, sweaty skin, and a significant rise or drop in skin temperature is commonly observed.

• Sudomotor/Oedema Disturbances: This includes significantly increased or decreased sweating and swelling in the affected body part.

• Motor/Trophic Disturbances: This includes impairment in motor functioning like muscle weakness, mobility-related issues, and trophic changes like changes in nail and hair growth.

Diagnosis

Diagnosing CRPS can be quite challenging and requires a multi-disciplinary approach. One needs to consult a pain specialist and a neurologist who understands pain issues well to reach the correct diagnosis. There is no single test that can detect CRPS. Apart from a physical examination the other tests that can be asked for are:

• Thermography (A test to show temperature changes and lack of blood supply in the affected limb)
• Bone scans
• Nerve conduction studies
• X-rays

(Source)
Treatments

There is no cure for CRPS, however the impact of the disease can definitely be slowed down. A CRPS warrior needs to undergo a combination of medicinal procedures which includes physiotherapies and regular exercise apart from the oral intake of medicines to sustain. In certain cases, CBT (Cognitive Behavioural Therapy) is also used in addition to Talk Therapy, Psychotherapy, depending on the CRPS warrior’s condition.

Worldwide there are many organisations working for CRPS like the Burning Nights, CRPS UK, CRPS Australia, CRPS US apart from Chronic Pain India. Our effort is to help pain warriors understand their pain better and address the issues faced by them in their healing.

We at Chronic Pain India strive to get the message across to each and every individual suffering in silence and be their voice. We hope that by spreading awareness about the condition we can help more people to come forward so that one day the narratives change with better treatments and outcomes.

(To be continued –Living with CRPS)

About the Author:

Punyyaa Anand is a girl with varied interests. Right from cooking gourmet food to looking after her siblings to reading spiritual texts to aspiring to be an independent researcher. She plans to pursue PhD in Public Health in a few years time.