When the patient is examined, they tend to protect that body part because of extreme sensitivity to touch. Typically, the patient describes the progressive onset of unrelenting pain, usually burning, electrical or stabbing in nature, starting several weeks after an injury. The most important diagnostic information is the clinical presentation, that is, the history that the patient provides, describing the nature and onset of symptoms, and physical findings when the patient is examined. Unfortunately, there is no test that is specific for CRPS. Our present understanding of CRPS is that it is produced by a complex cascade of physiological and biochemical changes that occur not only in the nerves of the affected body part, but also within the brain and spinal cord. The exact way that trauma, especially minor injury, can produce such debilitating pain is not known. In 1994, a workshop of experts on RSD changed the name to complex regional pain syndrome (CRPS), as it is now known. Sympathetic overstimulation to a region of the body results in cool, sweaty skin.Īs we learned more about this condition, it became apparent that RSD, as it was known, was a more complicated problem. In the skin, the sympathetic nervous system controls the blood flow through the small arterioles in the skin as well as the sweat glands. The sympathetic system is part of the autonomic nervous system (the other part is the parasympathetic system), which controls those functions of the body not under the direct, conscious control of the brain, such as heart rate, blood pressure and diameter of the pupils of the eyes. James Evans coined the term reflex sympathetic dystrophy, in his assumption that the sympathetic nervous system was the culprit. Weir Mitchill, a Union physician, reported in 1872 that he observed that some of the soldiers developed severe, chronic, unrelenting pain in an arm or leg after being wounded in that part of the body. This problem was recognized as far back as the American Civil War. A common scenario is a fracture, such as at the wrist, which is then immobilized in a cast with the ensuing CRPS developing over several days or weeks after the injury. Development of pain, along with these regional changes, usually takes several weeks to occur following an injury. Also, the body part is exquisitely sensitive to touch, even very light touch so that having bed sheets touching the skin is unbearable. These alterations include temperature changes, sweat pattern differences and changes in the appearance of the skin, as well as the nails and hair pattern. Associated with pain in that body part are skin changes, giving the term “complex.” In some cases, the patient does not remember a specific injury. The injury can be significant, such as a bone fracture, or relatively minor, such as an ankle sprain. Complex regional pain syndrome is a chronic pain condition that can occur in any part of the body however, it is usually regional, such as in an arm or leg, and often a result of an injury. The “Hell” refers to severe, unrelenting pain associated with this neurological disorder. The above statement was a slogan of the Reflex Sympathetic Dystrophy Association (RSDA), a national support group for patients with the diagnosis of complex regional pain syndrome (CRPS), formerly known as reflex sympathetic dystrophy (RSD). “If Hell were a medical condition, it would look like RSD.”
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