Complex Regional Pain Syndrome

CRPSComplex regional pain syndrome (CPRS), also known as reflex sympathetic dystrophy (RSD) and causalgia, is an exquisitely painful, unique neurological condition. Its hallmark is continuous, spontaneous pain in the periphery (usually arm or leg), following an initial injury. The injury, which may be a fall or crush, is usually rather minor, and the resulting pain is far more severe than would be expected from the initial injury.

After the injury, the pain is spontaneous, significant and continuous. Additionally, the pain demonstrates “hyperalgesia” and “allodynia,” that is, it severely worsens with minor touch or use. Even wind or clothing moving skin hairs—things that do not normally cause pain—cause excruciating pain. Later on, the affected area demonstrates continuous swelling, color and temperature changes (due to altered blood flow), and sweating abnormalities.

It is believed that the central nervous system (the CNS, consisting of the spinal cord and brain) in those suffering this condition becomes hyper-sensitized to pain signals coming in from the damaged area. As a result, there is an “amplification” of the normal pain and touch signals as they travel from the site, up the spinal cord, to the brain. These CNS changes also include abnormal signals from the brain to the damaged area, leading to weakness, neglect and possibly tremor there. These CNS changes are linked to changes in the autonomic nervous system, causing the sweating and blood flow abnormalities.

Conventional pain management for CPRS is varied. Medications include steroids, calcium regulating drugs (calcitonin), opiates, anti-inflammatories, and medicines often used for nerve-mediated pain: opiates, and medications in the anti-depression and anti-seizure classes. Some surgical techniques, including nerve ablation and spinal cord stimulation, have demonstrated relief. [1]

Neurological Scalp Acupuncture can produce marked improvement in CPRS. Likely by indirect stimulation of the somatosensory cortex [4], pain from the periphery such as CPRS-type pain may be ameliorated. Combined with ear and body acupuncture that provides electrical stimulation along the spine (Craig PENS protocol) [2], pain signals to the brain may be blocked. Chinese Herbal Medicine also is beneficial: it helps address any low-grade inflammation that may be perpetuating the irritation at the injury site.[2, 3]

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These brief overviews of conditions represent distillations of basic and current medical reviews from the following sources:

[1] Conventional Medical Sources

“Harrison’s Principles of Internal Medicine: Volumes 1 and 2, 18th Edition”. Dan Longo Anthony Fauci, Dennis Kasper, Stephen Hauser, J. Jameson, Joseph Loscalzo. McGraw-Hill Professional; (July, 2011)

Medscape eMedicine Physician’s online resource. Various review articles:

Complex Regional Pain Syndromes Treatment & Management.
Anthony H Wheeler MD. Medscape Reference Chief Editor: Stephen A Beman, MD PhD MBA.

Essential Tremor
Deborah A Burke, MD Clinician, Sub-Investigator, Movement Disorder/Parkinson’s Disease Center, University of South Florida College of Medicine; Investigator, Physician, Roskamp Institute Memory Clinic

Bell Palsy
Danette C Taylor, DO, MS Clinical Assistant Professor, Department of Neurology and Ophthalmology, Michigan State University College of Osteopathic Medicine; Senior Staff Neurologist, Henry Ford Health Systems

Meniere Disease (Idiopathic Endolymphatic Hydrops)
John C Li, MD Private Practice in Otology and Neurology; Medical Director, Balance Center

Restless Legs Syndrome
Ali M Bozorg, MD  Assistant Professor, Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida College of Medicine

Postherpetic Neuralgia
W Alvin McElveen, MD  Director, Stroke Unit, Lakewood Ranch Medical Center; Neurologist, Manatee Memorial Hospital

Sleep disorders
Roy H Lubit, MD, PhD  Assistant Clinical Professor, Mount Sinai School of Medicine; Clinical Faculty, Department of Child Psychiatry, New York University School of Medicine; Private Practice

Aaron G Benson, MD  Director, Ohio Hearing and Balance Institute, Maumee, Ohio; Consulting Staff, Toledo Ear, Nose and Throat, Inc

Multiple Sclerosis
Christopher Luzzio, MD  Clinical Assistant Professor, Department of Neurology, University of Wisconsin at Madison School of Medicine and Public Health

Parkinson Disease
Robert A Hauser, MD, MBA  Professor of Neurology, Molecular Pharmacology and Physiology, Director, USF Parkinson’s Disease and Movement Disorders Center, National Parkinson Foundation Center of Excellence, Byrd Institute, Clinical Chair, Signature Interdisciplinary Program in Neuroscience, University of South Florida College of Medicine

Tourette Syndrome and Tic Disorders
William C Robertson Jr, MD  Professor, Departments of Neurology, Pediatrics, and Family Practice, Clinical Title Series, University of Kentucky College of Medicine

Post Concussive Syndrome
Roy H Lubit, MD, PhD  Assistant Clinical Professor, Mount Sinai School of Medicine; Clinical Faculty, Department of Child Psychiatry, New York University School of Medicine; Private Practice

Traumatic Brain Injury
Segun T Dawodu, MD, JD, MBA, LLM, FAAPMR, FAANEM  Associate Professor of Rehabilitation Medicine and Interventional Pain Medicine, Albany Medical College

Dizziness, Vertigo, Imbalance
Hesham M Samy, MD, PhD  Head of Hearing and Balance Unit, Otolaryngology Department, Minia University, Egypt

CNS Causes of Vertigo
Marcelo B Antunes, MD  Resident Physician, Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Health System

Communication Disorders
Renee S Melfi, MD  Consulting Staff, Orthopaedic Associates of Central New York

[2], [3]

  • “Acupuncture Energetics: A Clinical Approach for Physicians”. Joseph M. Helms. Medical Acupuncture Publishers; 1st Edition. (1995)
  • “Foundations of Chinese Medicine: A Comprehensive Text for Acupuncturists and Herbalists”. Giovanni Maciocia. Churchill Livingstone; 2 Edition (July, 2005).
  • “Diagnosis in Chinese Medicine: A Comprehensive Guide”. Giovanni Maciocia. Churchill Livingstone; 1st Edition (January, 2004).

Chinese Scalp Acupuncture”. Jason Ji-shun Hao, Linda Ling-zhi Hao and Honora Lee Wolfe. Blue Poppy Press; 1st Edition. (November, 2011)