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What the heck is CRPS?


I am a nurse. I can honestly say that we were never taught anything about RSD/CRPS in nursing school. Let’s start with these initials. RSD stands for Reflex Sympathetic Dystrophy. It is also known as CRPS which stands for Complex Regional Pain Syndrome. It has also been known as causalgia. All of these names, are given to something that doctors and researchers don’t completely understand. What we do know is that it is a chronic pain condition where an injury causes pain that is totally out of proportion for that injury and lasts long after the injury should have healed. We also know that RSD affects the nerves, spinal cord and brain of the affected individual.
Today doctors and researchers still aren’t one hundred percent clear on what causes RSD to develop in one person and not in another with the same type of injury. Many physicians and nurses still do not know what RSD is so they do not know how to diagnose and treat RSD patients. There are many misconceptions about RSD held within the medical community.

So what exactly is RSD? It is a chronic neurological syndrome that is characterized by a severe burning pain that is often described by the people who have it as if someone poured lighter fluid on them and then lit them on fire. There are pathological changes in the bone and the skin, such as bone loss, and shinny, hairless reddish purple skin. Many people with RSD have excessive sweating all of the time in the affective area(s). The tissues of the effective area(s) swell. Most have are extreme sensitivity to touch (allodynia). Something as light as a breeze can cause excruciating pain. Clothing on the affecting area(s) can be painful. This last symptom can also cause people with RSD to pull away from the ones that they love. Touch is a sign of friendship and love. Many people can’t understand why you are constantly pushing them away and asking them not to touch you no matter how many times you explain why! Why? Because to someone with RSD, touch is extremely painful.

Anyone can get RSD. It is more prevalent in women than men and there are an increasing number of cases in children being diagnosed. One of the biggest challenges that the RSD patient face is the lack of proper understanding and education of pain management in the medical community. One of the biggest battles is that of getting treatments covered by health insurance and workman’s compensation insurance. This can be both frustrating and cause a delay in treatment. Delay in treatment can also cause progression of the RSD. Finally, the loss of employment, socialization and family life are all struggles that the person with RSD may be faced with.

RSD is a malfunction of part of the nervous system that usually develops in response to a traumatic even such as an accident or medical procedure. A minor injury such as a sprain, an IV stick, or a fall can all cause nerves to misfire sending constant pain signals to the brain. RSD is broken down into two categories:

CRPS I (RSD) – The symptoms of type I include: The presence of an initiating event such as a fracture, or sprain. Continuing pain including allodynia, which is pain from a normal stimulus, such as the breeze from a ceiling fan., Hyperalgesia which an increased sense of pain to an unpleasant stimuli. The pain is disproportionate to that associated with the injury. There is edema (swelling), changes in skin blood flow (skin color changes, skin temperature changes ) and excessive sweating in the region of pain. For example: I have RSD in my foot, a sheet touching my foot causes excruciating pain (allodynia). If someone accidentally stepped on my foot, the pain would be ten fold compared to someone stepping on the foot of someone without RSD (hyperalgesia). The pain continues to feel as though the foot is still injured months and years after that injury had healed or the pain is more intense than it was at the time of the original injury.

The diagnosis of CRPS I (RSD) is one of exclusion. It is based on the existence of conditions that would otherwise not account for the degree of pain and dysfunction. There is no one specific test or tests that can definitively diagnose RSD, although some doctors do use several tests that will be described later as diagnostic tools; they are not definitive in diagnosing RSD.

CRPS II (Causalgia) – In Type II, a definite nerve injury can be identified. The symptoms are the same as in type I, but the cause is different. This is the presence of constant pain, allodynia (pain resulting from normal stimulus) or hyperalgesia (an increased sense of pain) after an identifiable nerve injury. There is still evidence of edema, and skin changes. This diagnosis is also one of exclusion based on the existence of conditions that would otherwise account for the degree of pain and dysfunction from a nerve injury.