CRPS: Diagnosis and Prognosis

By: Traci Patterson, CH, CI and Owner, Advanced Pathways Hypnosis

As an individual that was diagnosed with CRPS (Complex Regional Pain Syndrome) I know there are a lot of questions about how patients are diagnosed and from there what is the prognosis for those patients.  I’ve put together some information to try to answer some questions that I’m asked quite often.

DIAGNOSIS

Currently there is no actual ‘one test’ that will give a definite positive diagnosis of Complex Regional Pain Syndrome (CRPS) aka Reflex Sympathetic Dystrophy (RSD).

Instead to receive a positive clinical diagnosis of CRPS/RSD, pain specialists and doctors use the current BUDAPEST CRITERIA 2004, which was brought out during the International Consensus Conference in 2004. This new diagnostic criteria takes over from the one from the International Association for the Study of Pain in 1994 (IASP 1994). The pain specialist or doctor will discuss with you your medical history, symptoms you may be having and any signs or changes. They also may do nerve conduction studies, EMG, MRI scan, x-rays, bones scans, and/or a thermal study.

If there is no known injury or illness that contributed to the problems then the doctors and specialists would carefully check to see if there is no other treatable condition that has been missed.

The BUDAPEST CRITERIA 2004 states that for there to be a clinical diagnosis of CRPS/ RSD certain criteria need to be reached.

These are:

  •  There needs to be lasting pain which is disproportionate to the initial injury or illness.
  • The patient also needs to be experiencing at least 3 out of 4 of certain categories listed below. If you are positive in any of these categories you need to tell the doctor / specialist that is treating you.

Specific Categories:

  1. SENSORY – This means that you describe symptoms of increased sensitivity or hypersensitivity on your limb
  1. VASOMOTOR– This is when you describe temperature differences in your limb and / or skin color changes and / or difference in your skin color between the limbs
  1. SUDOMOTOR / EDEMA – You describe edema and / or sweating changes and / or sweating asymmetry
  1. MOTOR / TROPHIC – Reports of decreased range of limb motion and / or abnormality of a muscle or nerve that effects or produces motion (including tremor, weakness, dystonia…) and / or trophic changes (includes changes in nails, hair, skin…)
  • You must ALSO show at least 1 sign observed by the doctor or specialist at your appointment, in 2 or more of the categories below:
  1. SENSORY– Evidence of hyperalgesia usually following a pinprick and / or allodynia (proof of pain to a light touch and / or deep somatic pressure and / or joint movement)
  1. VASOMOTOR – Proof of temperature change in 2 limbs or more and / or skin color changes
  1. SUDOMOTOR / EDEMA – Proof of swelling or edema and / or sweating changes and / or sweating asymmetry
  1. MOTOR / TROPHIC – Evidence of decreased range of motion and / or motor dysfunction (such as tremor, weakness, dystonia) and / or trophic changes (skin, hair, nails…)
  • If there is NO other diagnosis that could better explain the symptoms and signs observed during a physical examination, and you meet the above criteria then you will most likely be diagnosed with CRPS/RSD.

PROGNOSIS

If you receive early treatment following the injury or illness there is a little evidence or research to say that there is a fair chance of recovery or ‘remission’ as CRPS patients know it. It has not yet however been proven during clinical trials and studies concerning early treatment. However, the prognosis will be different for each sufferer as everyone is considered unique and their symptoms although they will have a common trait, will also vary.

Occasionally people are left with unrelenting, agonizing pain and irreparable changes regardless of what standard/traditional treatment is given to them.  I can’t stress enough, that more alternative and complementary treatment options need to be given to CRPS/RSD and chronic pain patients.  This is a starting point.  There are non-invasive treatment options currently available for CRPS patients at this time, but the hospitals and physicians are not utilizing them nor speaking to their patients about them.  Clinical/medical hypnosis/hypnotherapy has been shown to be effective in significantly reducing pain [I utilized clinical/medical hypnosis to get into remission, and I currently treat CRPS patients with clinical hypnosis and a multi-therapeutic approach to assist them in significantly reducing their pain and/or getting into remission.] and let’s not forget about Calmare Therapy.

More research is definitely require to help understand the actual causes of CRPS, how early treatment affects it, why it progresses in some people and not in others… The list is endless as to questions about CRPS – this needs to change.

In a recent study from 2014, Van Velzen, G.A.J. et al. (See below) concerning the quality of life, they concluded:

“We conclude that loss of QoL in CRPS patients is due mainly to reduced physical health. A comparison with data available from the literature shows that CRPS patients generally report poorer QoL than patients with other chronic pain conditions, particularly in the physical domains.”

(* QoL = Quality of Life)

Many children and teenagers who have been diagnosed tend to have a good recovery. According to Edward C.T.H. et al (See below for study details)

“The prognosis of childhood-onset CRPS I seems less favorable than usually reported, and is comparable to the prognosis of the adult-onset CRPS I in view of a decreased quality of life and a large relapse percentage (33%) at long-term follow-up.”

In another study by Finniss, D.G., et al. entitled ‘Complex Regional Pain Syndrome in children and adolescents’, (See below) it was said that:

“Early diagnosis, referral and appropriate intervention are essential in decreasing pain, suffering and resorting function for children and adolescents with CRPS.”

There is still more research to do to learn as much as we can about Complex Regional Pain Syndrome (CRPS) aka Reflex Sympathetic Dystrophy (RSD).  At this time there is no one specific test that can be done to diagnosis this condition.  The doctors and specialists are doing the best they can to confirm Complex Regional Pain Syndrome (CRPS) based upon the BUDAPEST CRITERIA 2004.  No, this is not perfect but it is aiding is the diagnosis and treatment of patients.

Research is slow when it comes to CRPS both in the US and in other countries.  There is some research that has shown that early diagnosis and early treatment will aid in the recovery and subsequent remission, but no clinical trials / studies have been completed to prove this.

I have personally experienced, treated and seen patients that have had CRPS from 1 years to 10+ years get into remission utilizing different non-invasive treatment options including clinical hypnosis.  We have to have studies done on all types of treatments, all stages of CRPS patients undergoing treatment and the efficacy of the treatments.  I think that the outcomes would be eye opening when it came to the money spent on Spinal Cord Stimulators and some of the other traditional treatments vs integrative and complementary treatments.

It seems that there is insufficient evidence in many areas of the condition that are unknown or understood by the health profession on a worldwide basis. This is something that has to change in order to increase the outcomes for CRPS patients.  That is the exact reason why Advanced Pathways Hypnosis is taking the steps to initiate data collection and a clinical study on the outcome of, “Clinical Hypnosis Utilizing a Multi-Therapeutic Approach with CRPS Patients”.  Please keep your eyes open in the near future for further information.

REFERRED TO RESEARCH / STUDIES / TRIALS