Dr. Siles Weir Mitchell MD is said to have discovered the Complex Regional Syndrome, also called Causalgia or Reflex Sympathetic Dystrophy Syndrome. He was a genius who had interest in diverse fields. Dr. Mitchell was a toxicologist, father of neurology, psychiatrist, hand surgeon, pioneer in scientific medicine, author, poet, and lived a celebrity life in Europe and America.
About complex regional pain syndrome
The complex regional pain syndrome is a chronic condition wherein pain occurs after an injury, affecting the arms and legs or any other part of the body. The severity of the pain depends on the injury and its intensity increases with time. This pain can take place rarely after surgery, heart attack, stroke, or any other health problem too.
Most of the individuals affected with this syndrome often acquire it due to injury or illness that does not directly harm the nerves of limbs that are affected. This condition falls under Type 1 complex regional syndrome. When the syndrome takes place due to nerve injury, it falls under Type 2 complex regional syndrome, also called causalgia. Some other factors that cause this syndrome include shrapnel blast, gunshot wound, surgery, heart attacks, infections, fractures, and sprained ankles.
Symptoms
Due to this syndrome, there is intense pain and burning sensation in the arms, hand, foot, or legs. The skin may turn more sensitive and change color to blue or red instead of mottled white. The skin may turn cold and sweaty, making it appear thin and shiny. There may be damage, swelling, and joint stiffness seen in the affected person. Some changes in nail and hair growth can also be observed. There is degeneration of muscle with weakness and spasms. The affected body part becomes immobile. This condition is irreversible, with varying symptoms.
Diagnosis
For diagnosis of this condition, a complete physical examination, along with medical history of the patient is required. A bone scan using a radioactive substance is done which is injected through the vein and viewed by a special camera. As a result, the affected parts/joints receive more blood which can be seen with the help of the bone scan. Thermography is a test conducted to measure the temperature of the skin and flow of blood to the affected and unaffected areas of the body. With the help of X-rays, bone mineral loss can be assessed in the later stages of the disease. Any changes in the tissue can be seen in an MRI scan (magnetic resonance imaging) which uses radio waves and magnetic field to capture 3D images of the body’s internal structures.
Treatment
Till date, there is no cure for complex regional pain syndrome. The treatment available is only to relieve the associated symptoms. To relieve pain, over-the-counter medications such as non-steroidal anti-inflammatory drugs such as ibuprofen, aspirin, and naproxen sodium are available on doctor’s prescription. Pain associated with a damaged nerve can be relieved using anticonvulsants such as gabapentin (Neurontin) and antidepressants such as amitriptyline which are prescribed by a doctor. Corticosteroids such as prednisolone may be given to reduce inflammation. To overcome bone loss, medications such as calcitonin (Miacalcin) and aldendronate (Fosamax) are given.
Application of hot and cold compress on the affected areas may reduce inflammation. If the area is cool to touch, heat application may provide relief. By exercising the affected area in a gentle manner, strength and movement of the affected muscles can be increased. In order to reduce hypersensitivity, application of topical analgesic creams such as lidocaine can be helpful. Also, a combination of clonidine, amitriptyline, and ketamine may be used. Injecting anesthetic can block the pain fibers in the affected nerves. Chronic pain in the nerve endings can be eased by the application of electrical impulses. Spinal cord stimulation is a procedure in which small electrodes are placed along the spinal cord and an electric current is passed through. This brings relief in pain. Biofeedback, a learning technique, can make a person more aware of his body and learn ways to relax it and get pain relief.
Coping with complex regional pain syndrome
Administration of Vitamin C after a fracture and being in a mobile state soon after a stroke tends to reduce the chances of acquiring complex regional syndrome. It is vital for people affected by this syndrome to take care of their physical and mental health; for this, they need to consult psychologists and therapists. Joining a support group can help as they can share their feelings openly and get good advice from others who are suffering from the same problem.
