Background Information on complex Regional Pain Syndrome

Complex Regional Pain Syndrome (also know as Reflex Sympathetic Dystrophy) is a chronic pain syndrome characterized by severe, unrelenting pain.  It has been estimated that upwards of 0.3% of the United States population is affected with this syndrome.

The exact cause of Complex Regional Pain Syndrome (CRPS) is unknown.  However, CRPS appears to be a malfunction of the nervous system occurring after an accident or medical procedure.  For reasons still poorly understood, the sympathetic nerve(s) begin to misfire. This misfiring results in constant pain signals being sent to the brain.

Symptoms of CRPS can include:

• Persistent moderate-to-severe pain
• Swelling (see photo below)
• Abnormal skin color (see photo below)
• Changes in skin temperature
• Excessive sweating
• Limited range of motion
• Movement disorders

The mean age for the onset of CRPS is 42. However, young children can be affected. Reported cases of CRPS in 3 year old children have been reported.  CRPS is nearly three times more frequent in females than males.

Current medical interventions for CRPS include:

• Medication
• Physical therapy
• Psychological support
• Sympathetic nerve blocks
• Spinal cord stimulation

Suggested medical intervention to prevent CRPS:

• Incorporating insoles into casts

In House Pilot Study - (1988-1991)

Study:  Review of charts of nearly 500 patients at Ballard Sports Medicine Clinic, Ballard Washington, 1989-1990 and Bellevue Foot and Ankle Center, Bellevue Washington, 1988-1991 who:

• Were casted following foot/ankle surgery or foot/ankle trauma
• Had insoles incorporated into their casts

Summary: Based on a reported 5% occurrence rate of CRPS in post trauma patients (Loeser,2001; Plewes, 1956) one would expect to see 2-3 cases of CRPS in the above study. 

Results:  Not one case of CRPS was reported. 

Conclusions: The results of this study are neither definitive nor inclusive, however, they do suggest a need for further investigation into using insoles inside casts to prevent the development of CRPS.

References

    Loeser JD. Ed. Bonica's the management of pain. 3rd Ed. Philadelphia, PA: Lippincott, Williams & Williams; 2001:388-411.

    Plewes LW. Sudek's Atrophy in the Hands. J Bone Joint Surgery 1956;38:195-203.

    Coach Marla's website on Reflex Sympathetic Dystrophy - an excellent website on RSD which I strongly recommend.

Professor/Dr. Brian A. Rothbart
Chronic Pain Elimination Specialist

Discovered the Rothbarts Foot and PreClinical Clubfoot Deformity
Developer of Rothbart Proprioceptive Therapy
Designer of Rothbart Proprioceptive Insoles
Founder of International Academy of Rothbart Proprioceptive Therapy
Author of Forever Free From Chronic Pain

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