Monday, 6 November 2017

November is Complex Regional Pain Syndrome Awareness Month | CRPS Awareness Day

     Hello everyone. I hope you all are doing well. I am doing pretty good. Busy with school and all. The semester is wrapping up soon so I’m constantly working on getting my grades up. I'm sure you're getting sick of all my "awareness" posts but I promise you, there are only two more (this one and then one more) later this month. Today's topic is near and dear to my heart and that is Complex Regional Pain Syndrome.
     I was diagnosed with CRPS on June 28th 2017 and I have it in both my legs from above my knees down after being immobilized in multiple plaster and boot casts between end of August 2016 and beginning of June 2017. I know now that all of my foot/ankle problems are primarily due to my broken back which you can read about here
     As always I will explain what CRPS is, the symptoms, diagnosis and treatment. So without further ado, lets begin!

What is CRPS?
     Complex Regional Pain Syndrome or CRPS for short is a progressive disease of the Autonomic Nervous System, more specifically the Sympathetic Nervous System. CRPS is classified in two types. 
     Type I, formerly known as Reflex Sympathetic Dystrophy involves a minor nerve injury when you have chronic pain after a limb has been immobilized for a long period of time due to surgery or a broken bone. Medically, via MRIs and other various scans, you might not see anything wrong with the affected limb, but it still hurts. That is due to the nerves in the affect limb over-firing due to a short circuit in the spinal cord. 
     Type II, formerly known as Causalgia, involves a major nerve injury usually in the Peripheral Nervous System. This trauma can be from a simple injury as stated in Type I or something more severe such as SCI (spinal cord injury). As this type progresses you may loose function in that are due to the nerve damage. 
     CRPS can occur in any area of the body but is typically the arms or legs. It can travel up or down a limb or it can “mirror” or transfer the same symptoms on to the opposite limb.

What are the symptoms of CRPS?
The four main symptoms from American RSDHope are as follows:
  1. Constant chronic burning pain - The pain, which is usually significantly greater than the original event/injury;  though the affected area may feel cold to the touch to the patient it feels as though it is literally on fire; and is ranked as the most painful form of chronic pain today by the McGILL Pain Index. This symptom also includes allodynia which is an extreme sensitivity to touch, sound, temperature, and vibration.
  2. Inflammation - this can affect the appearance of the skin, bruising, mottling, tiny red spots, shiny, purplish look; as well as affect the skin temperature of the affected area, cause excessive sweating, etc.
  3. Spasms - in blood vessels (vasoconstriction) and muscles (sometimes referred to as rolling spasms) of the extremities.
  4. Insomnia/Emotional Disturbance - includes the major changes to the limbic system such as short-term memory problems, concentration difficulties, sleep disturbances, confusion, etc.

How is CRPS diagnosed?
     There is no definitive test to diagnose CRPS. Usually you’ll see a physician, typically a neurologist who is educated in CRPS. CRPS can primarily be diagnosed via physical examination, and your medical history. Other tests that are used to rule out other possible conditions. Some of those tests are bone scans which helps detect bone changes via a radioactive substance that is injected into a vein and then viewed via a tiny camera. Sympathetic nervous system test are used to look for disturbances in your sympathetic nervous system. For example, thermography measures the skin temperature and blood flow of your affected and unaffected limbs.
MRI's are also used to to look for tissue changes and X-Rays are used to look for a loss of bone mineral density which happens as the condition progresses.

What is the treatment for CRPS?
     There are many treatments for CRPS such as pain medications such as Gabapentin but the more effective treatments are Spinal Cord Stimulators the block the CRPS pain by sending small electrical signals to the affected limb, or Ketamine infusions which block NMDA receptors. 
     Here is an excerpt from Pain Medicine Journal about Ketamine infusion, "Although Ketamine
may have more than one mechanism of action, the basis for using it to treat CRPS/RSDS may reside in its strong ability to block NMDA receptors. Experimental evidence suggests that a sufficiently intense or prolonged painful stimulus causes an extraordinary release of glutamate from peripheral nociceptive afferents onto dorsal horn neurons within the spinal cord. The glutamate released, in turn, stimulates NMDA receptors on second-order neurons that produce the phenomena of windup and central sensitization. It is reasonable to consider that, by blocking NMDA receptors, one might also be able to block cellular mechanisms supporting windup and central sensitization. Ketamine is the only potent NMDA-blocking drug currently available for clinical use. Our interpretation is that an appropriately prolonged infusion of Ketamine appears to maintain a level of Ketamine in the central nervous system long enough to reverse the effects of the sensitization process and associated pain."

So that is it for this post. I hope you all enjoyed it! As always please give this post a +1 if you have a Google+ account, follow me on all my social media accounts and share it with your friends.

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