Chronic pain syndrome

Sudec /CRPS

Complex regional pain syndrome

The Complex regional pain syndrome (CRPS) is a chronic neurological disease, which occurs after a soft tissue or nerve injury, often in connection with the fracture of an extremity. The development of the CRPS is unknown, it is regarded as a complication in the course of the disease.

The term “Morbus Sudeck” is considered outdated. The CRPS combines the following terms, which are not or less in use today: reflexive dystrophy, Morbus Sudeck, Sudeck-dystrophy, algodystrophy and symphatic reflexive dystrophy.

Symptomes express themselves in circulatory disorders, edema, skin changes, pain and functional limitations. Older people are more affected by this disease in the upper limbs than the lower, it is relatively common after radius fractures and shoulder surgeries.

The course of the disease is highly individual. Mild forms of the course can spontaneously return after several weeks. In other cases the disease increases its intensity and can be so severe that a normal life is almost impossible.

CRPS Type I: CRPS, which occurs after a trauma or an immobilization of an extremity (limb), but without a specific nerve damage.

CRPS Type II (causalgia): CRPS, that occures after a nerve injury, but nor necessarily limited to the site of injury.

The classification of severity

  • Degree 1 (urgent stage): Circumsribed pain at the site of injury, hyperesthesia, edema, muscle cramps, restriciton of mobility and hyperhidrosis. 
  • Degree 2 (dystrophic stage): Increasing, diffuse pain, edema, disturbance of growth of hair and nails (dystrophy), osteoporosis, incipient myodystrophia. Sometimes additional to that bleeding of subcutaneous tissue. 
  • Degree 3 (atrophy stage): large-scale pain, irreversible atrophy of tissue, generalization of the medical conditions. 

Some authors have also defined a fourth degree of severity, which is characterized by an immune system disorder, generalized edema and the change of hypotonia and hypertension.

Most important ist he early recognition of CRPS. The sooner it is known and treated appropiately, the better ist the course of health and the healing result.

The CRPS is treated with medication. In order to influence the swelling and the pain most positive, the treatment usually consists of lymphatic drainage, bandaging and active exercise before the initation of pain.

The aim of the treatment of CRPS is pain reduction and mantainance of mobility. It is very important to find the optimal balance between active exercise and not increasing the pain. The coordinated cooperation of patient, doctor and therapist is essential to provide the optimum support for the healing process.