How To Best Treat CRPS On An Individual Basis

March 25, 2019 / Thomas Cohn, MD

crps Complex regional pain syndrome is one of the most vexing and difficult problems in the world of pain medicine. Traditionally it was thought to be a rare disorder that spontaneously affected some people especially after some sort of injury. Since it has been poorly understood, many pain practitioners have very limited experience and interest in trying to treat this condition. Many physicians actively try to avoid working with patients with the problem, others may try a few things but since they have limited knowledge and experience, they often end up giving up on trying to manage the problem. Luckily there are more than a few pain physicians who see the condition a lot and are becoming more successful with its management.

The thought leaders in pain medicine who treat CRPS seem to be some of the physicians who do a lot of work as interventional pain physicians who also take a very active role in diagnosis of their patients besides just providing treatments. The ability to fully evaluate a person is critical in understanding CRPS. The symptoms of CRPS always have a cause; it is not just a bunch of symptoms that lead to a painful extremity. It usually involves a structure in the body such as joint that is malfunctioning or a nerve in the area that is abnormally functioning. Treatment is needed to correct the structure that is not moving in the right way and to relieve the abnormal functioning of the nerves involved in the area.

The Challenges of CRPS

The first challenge is correcting the structural problems that often are orthopedic in nature that are wrong. The abnormal movement sends signals through the nervous system that something is wrong and often is interpreted by the brain as pain. These problems may start as simple degeneration like from a sprained ankle or a worn out knee. Most of the time, correcting the simple problems work, but if there are nerves malfunctioning in the area, possibly damaged by an injury or treatment, or more centrally also in the spine itself, then complex regional pain syndrome – CRPS may be manifested. The major challenge is finding the nerve problems correlated with the symptoms and finding a way to treat them.

Since CRPS often now is thought to involve peripheral nerve injury in the region of pain, then finding the nerve and extinguishing the signal from that location can sometimes effectively treat the problem. If the source of the pain is strictly peripheral, finding the right nerve and blocking that nerve proximal to the damage may stop the pain. In the last 1-2 years, technology has improved and techniques are now becoming available to electrically block isolated nerves in the extremities.

Spinal cord stimulation has been used to treat CRPS for years, and this is blocking signals more centrally at the spine. Now technology is allowing pain practitioners to more precisely block the nerves either as they exit the spine or superficially in the periphery with special implantable devices. Obtaining better pain control then involves the physician fully evaluating a person for all the places that may be contributing to sending painful sensory signals and then trying to find the simplest place to block the abnormal electrical signals such that they do not travel to the brain and signal pain and disaster to the brain. Further it means the physician who is going to be helpful in treating your pain must be fully evaluating the patient as well as working directly with the interventional techniques. A physician who is just providing injections or not fully involved in all aspects of pain management is unlikely to understand and be helpful in controlling symptoms in CRPS.

The understanding and treatment of CRPS is changing and with the right providers, pain control is often being significantly improved. This is not a mystery disease, but unfortunately not many physicians have seen enough of these types of problems to understand and manage the complex issues. Finding the right person is difficult, but the interventional pain physicians who see CRPS a lot, who actually evaluate their patients themselves and do the treatment may be the best source for a successful strategy toward treatment. The solutions sometimes are complex like the disease, but there are more and better treatments that are becoming available.

CRPS – The Pain Is Real

January 20, 2017January 25, 2017 / Thomas Cohn, MD

Recent findings suggest that individuals with complex regional pain syndrome deal with a great amount of pain during every day activities. According to some pain scale rankings, CRPS ranks higher on the pain scale than childbirth, cancer and even amputation.

For those of you unaware of what complex regional pain syndrome is, CRPS is categorized as a chronic condition that typically affects one limb, usually arising out of a trauma. CRPS involves a disruption in the way sensory signals are processed and deciphered along the central nervous system, leading to extreme pain even when no traumatic experience is happening. Actions like putting on your socks or brushing against a door frame can trigger inflammation and painful sensory signals.

Treating CRPS

According to the National Institutes of Health, CRPS typically affects women, and the average age of a CRPS sufferer is 40 years old. The issue with CRPS is that since it involves a communication breakdown in the central nervous system, it can be extremely hard to diagnose correctly. One report suggests that the average CRPS sufferer searched for answers for four years before receiving the appropriate diagnosis. Part of the problem is medical oversight, but this is due in large part to it being such a rare condition, and the fact that research dollars are being spent elsewhere.

So how do we work to treat and prevent this problematic condition? For starters, education is key. That’s the main reason we shared a large infographic about CRPS on the blog earlier this week. Both patients and healthcare providers need to be aware of the problem of CRPS. It can be treated and managed, but only with an accurate diagnosis. People should not have to wait four years to get to the bottom of their health problem.

Funding For CRPS

We also need to be spending more research dollars on understanding chronic conditions. Chronic pain affects roughly 30 percent of Americans, and the toll it takes on the healthcare system as a whole is billions of dollars, yet funding to better understand the condition and help those who suffer day in and day out continues to be lacking.

St. Paul CRPS Pain Doctor

If you’re dealing with chronic pain, and you’re struggling to get answers about your condition, set up a consultation with a Minnesota Pain Specialist. We won’t stop until we get to the bottom of your condition, because our goal is to help you live a pain-free life. Contact us today for more information.

What Is Complex Regional Pain Syndrome?

January 17, 2017 / Thomas Cohn, MD

Complex Regional Pain Syndrome (CRPS) is a complicated condition in which nerves incorrectly send pain signals to the brain, even though there is no painful sensory action taking place. For people with CRPS, actions like a gust of wind on their neck or toweling off after a shower can trigger a painful flareup. CRPS can be difficult to treat because it can be difficult to pinpoint exactly where the problem is along the nerve path to the brain. However, with careful evaluation and coordinated treatment with a pain management specialist, symptoms can be kept under control.

Today, we want to take a closer look at CRPS by partnering up with our friends at Burning Nights CRPS. They’ve created a wonderful infographic that examines the problems caused by CRPS and what actions you can take if you’re suffering from the condition. Check out the infographic below, and be sure to swing over over to BurningNightsCRPS.org to learn more about CRPS and other chronic conditions.

CRPS Infographic

CRPS, Chronic Pain and Your Brain

March 25, 2015 / Thomas Cohn, MD

Pain is an extremely complex issue. Complex regional pain syndrome (CRPS) is a prime example of the new understanding pain specialists are finding in the world of pain. Explaining these problems have taken years, but we are finding new information on what is happening when these conditions develop. We know now that there are peripheral issues at the site of injury, problems at the spinal cord and the equivalent of a short circuit in the brain when these conditions occur. Pain is maintained by feed-forward pain reception and feed-back sympathetic efferent loops. The brain stem, hypothalamus, limbic system and cortex all play roles.

Once an injury occurs, pain receptors in the periphery of the body, at the skin, bone and joint start sending signals to the brain. The sensory fibers first go to the periphery of the cord – the dorsal root ganglion where the sensory cell bodies are located. These cells then send signals to the cord in the dorsal horn and then to the brain. At this point, the cells in the DRG also are putting out several inflammatory chemicals IL-1, TNF, and IL-6 that promote inflammation in the periphery and increase the pain sensitivity of the spine and brain. Not only do the nerve cells become active, but glial cells, which we thought were just inert insulation, become active and produce more of these chemicals that promote inflammation. These chemicals then make the nerve cells more sensitive to pain reception and increase the number of signals going to the brain.

Pain and Brain

The brain is the master processing of all nerve and chemical signals in the body. The signals from the periphery for pain travel to the brainstem, then to the hypothalamus, thalamus, limbic system and cortex. The chemicals produced in the periphery also sensitize the brain also to pain signals. There are also an increased number of signals going to multiple areas of the brain, overwhelming certain areas and stimulating brain areas that are active for anxiety and depression in the cortex and limbic areas. Furthermore, the increase in signals also interacts with the motor inhibitory signals that are supposed to block pain signals. Thus in CRPS, there are multiple regions with increased activity, from the periphery to the spinal cord and into the brain.

The treatment of CRPS is now becoming more complex. The first obvious treatment is to try to eliminate the factors in the periphery that are stimulating the sensory signals. This means trying to correct even the small injuries that stimulate pain receptors, allow healing of the injury. During the treatment of the injury, interfering with the delivery of signals to the cord and brain is also important. This may be done with a variety of interventional techniques, physical therapy, medications, and psychological techniques. When the peripheral treatment of the injury is incomplete, then a full array of pain management techniques may need to be fully explored and treatment needs to be coordinated by a knowledgeable pain management specialist with expertise of medications and advanced interventional techniques including implantable options.