Three years ago, Mr. Gordon stepped “the wrong way” when getting out of bed one morning; the resulting foot pain was excruciating. Since that day, even lightly touching the skin of his foot causes Mr. Gordon pain. Sometimes his foot swells and the pain worsens in cold weather. X-rays taken at the time of this mishap did not reveal a fracture.
While Mr. Gordon continues to experience pain, his doctors aren’t sure what is causing it. Since all his test results are “normal” and none of the treatments has helped him, his doctors assume that his pain is “psychological” in origin.
Complex Regional Pain Syndrome (CRPS), formerly known as Reflex Sympathetic Dystrophy (RSD), is a disease in which the portion of our nervous system that normally conducts pain becomes oversensitive. The result of this “sensitization” is spontaneous pain. This kind of pain persists despite the fact that there is no apparent cause (such as a fractured bone or infection), although the symptoms may emerge following a fall, injury, cut, or burn. Researchers have discovered that microscopic changes in nervous tissue can produce the chronic pain associated with CRPS.
Not every case of CRPS is the same and there is no reliable test for diagnosing this syndrome. It is, as doctors often say, a “diagnosis of exclusion” — that is, if all other causes of pain have been ruled out, doctors may attribute the pain to CRPS. Similarly, there is no treatment “recipe” for CRPS. Treatment regimens usually are tailored to the individual’s particular form of pain.
Some people benefit greatly from various types of nerve blocks. They are very safe and usually do not cause much additional pain. Sometimes a series of blocks is needed to achieve an adequate outcome.
Others have a better response to medication. In people with pain resistant to blocks and medications, implantable devices, such as spinal cord stimulators, can be helpful. These devices look like the pacemakers used for patients with heart disease. Once attached to the spine, they can significantly reduce the pain resulting from CRPS.
A third group might benefit from some combination of these approaches and the addition of physical therapy. A psychologist or other mental health professional can help to reduce depression and improve family relationships that may have deteriorated through the course of chronic pain.
It might be unrealistic to expect that even this range of treatments will entirely eliminate the pain of CRPS. However, a significant decrease in pain and increase in functioning may be expected. As the pain is reduced, psychological suffering often lessens.
After several nerve blocks, a new medication regimen, and a full physical therapy program, Mr. Gordon is feeling much better. His pain, although still present, has decreased, and the depression associated with his physical suffering has diminished considerably.