Complex Regional Pain Syndrome

Complex Regional Pain Syndrome (CRPS), also known as Reflex Sympathetic Dystrophy (RSD) or Causalgia, is a condition that is fairly close to home for me, namely because I suffered from it for six months and therefore learned quite a lot about the disease through frequent trips to the hospital, seeing various different specialists.

CRPS is hard to diagnose, as there is no specific test for it, it is simply diagnosed through a 'process of elimination'.  It  is a progressive disease which usually affects the extremities (arms and legs) but can spread to other parts of the body.

There are two different types of CRPS; Reflex Sympathetic Dystrophy and Causalgia.  RSD does not have obvious nerve damage, whereas Causalgia does.

The cause of this condition is currently unknown.  Contributing factors include injury and major surgery, however there are cases, like mine, where there is no obvious trauma to the area and therefore no clear reason.

There are three stages of CRPS:

• Stage One: severe burning pain at the sight of the injury, muscle spasm, joint stiffness, restricted mobility, rapid hair and nail growth and changes in the colour and temperature of the skin
• Stage Two: more intense pain, swelling spreads, hair growth diminishes, nails become cracked and brittle, osteoporosis becomes severe and muscles atrophy
• Stage Three: irreversible changes in the skin and bones, pain is unyielding, marked muscle atrophy, severely limited mobility

The picture (right) paints a fairly comical picture of Reflex Sympathetic Dystrophy, but it is far from that. The picture is actually a picture of my foot at its worst. 

It's hard to tell from the picture, but the swelling around my foot and my ankle was so severe that I began to develop stretch marks, the skin was pulled so taught that it was dry and cracking in places and the swelling had begun to travel up my leg at this point, reaching my knee.  

The pain that those six months caused was too much to describe, not only did I have the hideous burning sensation when I tried to weight-bear, but I had the added problem of spending six months on crutches which was, at times, unbearable, I had severe joint pain in my ankle and my toes and even now, six months on, I cannot move all of the toes on my left foot.

As you can see from the picture (left), the swelling in my foot and leg was simply fluid, which I was able to manipulate and make dents in.  

I had to visit a Rheumatology clinic once a week for four months, where I saw a consultant and was given a treatment plan of intense physiotherapy and hydrotherapy.  

I was prescribed dose after dose of high level painkillers; ibuprofen, paracetamol, co codamol, dicolfenac - but none of them ever seemed to work.  Eventually the rheumatology consultant precribed me a 25 mg dose of Amitriptyline, which at a higher dose is used as an antidepressant, because I wasn't sleeping at night.  Amitriptyline acts on the nerve cells in the brain, and whilst it relieved enough of the pain to sleep, the symptoms were never fully gone. 

After months of grueling physiotherapy and hydrotherapy (and wearing compression socks and tubular bandages), I managed, with the help of my physiotherapists and my hydrotherapist, to desensitise my foot and remove all swelling and most importantly, learn to walk after six months of crutches! 

(Left) My foot at its normal size, six months after recovering from RSD.