CRPS, Chronic Pain and Your Brain

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.

CRPS

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.

Complex Regional Pain Syndrome in Minnesota

CRPS in MinnesotaComplex regional pain syndrome (CRPS) is a difficult medical issue to treat. If you think you may have it, you want it gone. Unfortunately, there are few physicians and even less specialists who understand it and are able to manage the problem. Pain specialists, neurologists, and many other experts struggle with the diagnosis and treatment of the condition. In any field of work, 90% of people do a good job, however with CRPS, you need to find the 10% who are superior in their skill level. They are the artists, they put in a phenomenal effort to find a cause and a set of solutions to cover all the complex interrelated issues.

The starting point with complex regional pain syndrome is finding a Pain Specialist certified by the American Board of Physical Medicine and Rehabilitation. These are medical doctors with the extensive qualifications in all aspects of understanding pain. Board subspecialty qualifications insures a higher level of knowledge. The next quality is that the physician sees and treats the problem frequently. If they only see a couple of cases a year, it is unlikely they will have the interest and skill needed to successfully manage the problem. If the doctor walks into the room, immediately knows what is wrong and can talk to you sensibly about the problem, you have found the expert. He will also take a team approach to treating you, guiding you through any additional diagnosis and the variety of treatment options.

Treatment of CRPS

A CRPS expert will also understand this is a not a final diagnosis. CRPS is being caused by some sort of damage to the a particular region of the body. Finding the cause behind CRPS is essential in finding the route to managing and possibly resolving some or most of the pain. Treating symptoms rarely treats the CRPS. An expert will dig deep to find the all the issues that stimulate the sympathetic nervous system maintaining the pain. At times, treating the underlying problems resolves the CRPS. Unfortunately, at times, the damage to structures cannot all be solved and residual issues remain despite the best management.

Complex regional pain syndrome affects both the upper and lower extremities. Finding the diagnosis that is causing the problems is essential in treating CRPS. Treating the symptoms is helpful initially, but treating the underlying problem is essential in improving the outcome. In the lower extremity, orthopedic injuries especially to the foot and ankle cause CRPS in about five percent of individuals. Common causes include injuries to the ligaments and tendons of the ankle and foot that caused instability. Surgical management of the foot and ankle problems, along with aggressive simultaneous lumbar sympathetic injections may resolve the issues. Complex regional pain syndrome is less common in the upper extremities, but is also related to ongoing, unresolved injuries that are continuing to stimulate pain signals.

Find a Minnesota Pain Doctor

Finding a pain specialist who understands the complex issues related to the pain is difficult. Experience and training is essential to achieve a good outcome. Look for the physician who sees many patients with this problem on a regular basis. If the physician has not seen these patients frequently, it is unlikely that you will be satisfied with your treatment results. CRPS is a difficult problem to treat and finding the pain specialist with experience is necessary for a satisfactory outcome.