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The Hidden Pain Syndromes: Complex Regional Pain Syndrome / Reflex Sympathic Dystrophy

Complex Regional Pain Syndrome Wrist Pain Ankle Pain
In this blog post, I'd like to address an uncommon, but not rare condition, which is probably under-diagnosed due to the difficulty of diagnosis and treatment. I've had much experiencing identifying patients with this condition and have great success in treatments, in both my Interventional Pain Management Fellowship and while out in clinical practice.
Imaging bumping your toe or twisting your ankle or wrist, and all off a sudden, you develop hot burning pain in that area for the next several months that prevents you from working. Seems ridiculous, right? Unfortunately, for some people, it's reality. And it has a genetic basis.

Complex Regional Pain Syndrome (CRPS) and Reflex Sympathetic Dystrophy (RSD) are two closely related pain conditions that an interventional pain management specialist is adept at diagnosing and treating. What makes these issues challenging for most doctors to recognize is that there is no laboratory test or imaging test that confirms the diagnosis of CRPS/RSD. 

CRPS/RSD are called "clinical diagnoses" or "diagnoses of exclusion" and frequently, your pain doctor may need to order certain tests or images to see if there is an otherwise easily treatable condition, like  obvious nerve damage or sciatica, or even an unrecognized fracture or infection.
Patients with CRPS/RSD develop hot burning or tingling pain in a particular area, which does not get better over time. Sometimes the patient notes swelling, redness or warmth in the area, which may come or go. Hyperesthesia, meaning a light touch feel like fire, or anesthesia, or numbness, can occur as well.
If left untreated, patients stop using the area and can develop disuse atrophy, or muscle and skin wasting, as well as chronic pain in the area.
Hands and feet are most likely to be affected, sometimes after a minor, uneventful surgery, or sometimes after something benign as an ankle sprain or possibly a fracture. However, CRPS/RSD can also be found in every other part of the body. Suprisely, even when a fracture is fixed, hot burning pain and redness may persist. After an ankle fusion by even the most skilled orthopedist, patients' pain levels sometimes persist, and it's no ones fault.
Pain doctors are uniquely in a position to identify this early to to begin a comprehensive and multi-modal treatment, as a variety of approaches are helpful to combat this stubborn and otherwise debilitating condition. Multimodal treatment encompasses use of certain low dose medications, minimally invasive interventions, techniques of mindfulness, and physical rehabilitation. Early intervention is key, in order to rehabilitate the area prior to disuse atrophy, or skin and muscle wasting.
I'm passionate in helping patients alleviate CRPS/RSD and returning to normal function as efficiently as possible while minimzing pain. CRPS/RSD is a treatable condition! 
Please feel free to contact our office at 425-998-7884 or visit our website at if you think that you or family is affected by this condition, and set up an evaluation, or to send us a message. 
Robert Bowers MD

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