Complex Regional Pain Syndrome Sudeck’s disease, also called Complex Regional Pain Syndrome, CRPS I, is a rare form of chronic pain that usually affects one arm or one leg. Sudeck’s disease typically develops after injury, surgery, stroke, or a heart attack, and the pain is disproportionate to the severity of the initial cause of the disease.
What is Sudeck’s disease?
‘ Sudeck’s disease is characterized by continuous burning and throbbing pain, usually in the arm, leg, hand, or foot. The characteristics of Sudeck’s disease can change over time and vary from person to person. See growtheology for Comprehensive Guide to Hepatic Coma.
Sensitivity to touch or cold, swelling of the painful area, changes in skin temperature and color are just a few symptoms of Sudeck’s disease. If changes in hair and nail growth, joint stiffness, muscle cramps and reduced mobility of the affected body part occur, the condition is often irreversible.
Sudeck’s disease can be made worse by emotional stress. In the case of constant severe pain that only affects the limbs and seems unbearable, a doctor should be consulted, since the chances of a cure for Sudeck’s disease increase with timely diagnosis.
It is believed that Sudeck’s disease is caused due to a disturbed interaction between the nervous system and inappropriate inflammatory responses. There are two types of Sudeck’s disease with similar signs and symptoms but different causes.
Formerly known as reflex sympathetic dystrophy syndrome, Sudeck type 1 disease occurs after an illness or injury that does not directly damage the nerves of the affected limb. More than 90 percent of all cases of illness belong to this type.
Sudeck’s disease type 2 (causalgia) affects a direct injury to the nerves. Many cases of Sudeck’s disease occur after severe trauma, such as crush injuries, fractures, or amputations. Other injuries resulting from surgery, heart attacks, infections, and even sprained ankles can also trigger the condition.
Symptoms, Ailments & Signs
In the early stages, Sudeck’s disease is usually noticeable through inflammatory changes near the originally injured area. The typical signs of inflammation, redness, swelling and overheating, are accompanied by functional restrictions and pain, which can be excessive. As the disease progresses, the intensity of the pain decreases, and those affected are often completely pain-free.
The skin is initially pale and cool, later it appears noticeably thin. Connective tissue and muscles shrink significantly, the affected joints stiffen: In the worst case, they become completely non-functional. The disease equally affects sensors, motor functions and the autonomic nervous system. Sensory disturbances are expressed through abnormal sensations and disturbed body perception in the area of the affected extremity.
Pain can occur both at rest and under stress and is often triggered by the smallest stimulus such as a light touch. The mobility of the diseased joints is massively restricted, and involvement of the fingers is associated with the loss of fine motor skills.
Due to pain and muscle loss, the affected body region can only be loaded to a limited extent, and movements can be carried out with less effort. Damage to the autonomic nervous system results in altered skin blood flow and thus a change in skin temperature and color. Edema often develops on the diseased parts of the body, and the growth of hair and nails can be disturbed.
Diagnosis & History
Diagnosis of Sudeck’s disease is made through a history of medical treatments and a physical examination. Bone scans can be used to diagnose bone changes associated with Sudeck’s disease.
A radioactive substance is injected into a vein, which allows the bones to be viewed with a special camera. Tests of the sympathetic nervous system use thermography of skin temperature to examine blood flow to the limbs or to determine the amount of sweat secreted. Deviating results can indicate Sudeck’s disease.
Magnetic resonance imaging (MRI) can also document tissue changes. Good preparation for the medical anamnesis to diagnose Sudeck’s disease is advisable. For this purpose, all symptoms should be precisely localized, stating their degree of severity, and documented, stating the duration and intervals.
Patients primarily suffer from chronic pain due to Sudeck’s disease. In the worst case, this can also lead to a stroke or a heart attack, which can also be fatal for the patient. The life expectancy of those affected is significantly restricted and reduced due to Sudeck’s disease.
It is not uncommon for patients to suffer from swelling or reddening of the skin. Itching on the skin can also occur. The extremities of those affected are often warm, and tremors can also be felt. Muscle cramps can also occur, which are relatively painful. It is also not uncommon for patients to suffer from paralysis and sensory disturbances, which can occur in different areas of the body.
Pain at night can also lead to significant sleep disorders and thus to irritability in the patient. The quality of life is significantly restricted and reduced due to the disease. The treatment of Sudeck’s disease is usually causal and depends on the underlying disease. Furthermore, the patients are often dependent on taking painkillers. Whether this will lead to a reduction in life expectancy cannot usually be predicted in general.
When should you go to the doctor?
A doctor should be consulted if severe pain occurs over a long period of time after an injury that goes far beyond the normal level of the injury. As a rule, the arms or legs are affected, but in rare cases Sudeck’s disease can also develop in other parts of the body.
Sensory disturbances such as burning skin, tingling or hypersensitivity to touch should also be presented to a doctor, and movement disorders such as muscle twitching, muscle weakness, tremors or restricted mobility of the affected body part should also be considered Sudeck’s disease requiring treatment. Other symptoms that should prompt a doctor’s visit are water retention and heavy sweating in the affected areas – especially if these feel significantly colder or warmer compared to other areas of the body. Alarm signs can also be accelerated growth of hair and nails in the affected area.
The first point of contact if you suspect Sudeck’s disease should be your general practitioner. Since the disease cannot always be diagnosed with certainty right away, referrals to specialists in neurology and orthopedics are often made for further clarification . If the pain is severe, it is advisable to consult a pain specialist; in severe cases, inpatient treatment can take place. Psychotherapeutic support is also recommended.
Treatment & Therapy
If treatment of Sudeck’s disease begins early, improvement or remission is possible. An individual combination of different therapies is often necessary. To treat the symptoms of Sudeck’s disease, taking medication is helpful in addition to therapies.
If simple painkillers no longer relieve the pain, taking opioid painkillers may be advisable. In addition to thermal applications, various creams are used in Sudeck’s disease to reduce hypersensitivity. Physical therapy reduces pain and promotes mobility. Chronic pain can be relieved by applying electrical pulses to nerve endings (transcutaneous electrical nerve stimulation) or by stimulating the spinal cord.
If treatment is started too late, patients often have to adjust to life with Sudeck’s disease, which can put a great deal of strain on their entire living environment. In order to cope better with life, relaxation techniques such as biofeedback help those affected to develop better body awareness and relax more easily. The pain caused by Sudeck’s disease can increasingly burden mental health, so the support of a therapist is recommended.
Outlook & Forecast
The prognosis for Sudeck’s disease depends largely on how the affected person deals with the pain. It has been shown that a positive or optimistic attitude towards the curability of the condition significantly improves the prognosis, while preoccupation with the worst of the consequences leads to a worsening. It is worth knowing that in more than 80 percent of those affected, thanks to good and diversified therapy, a condition is reached that can no longer be diagnosed as Sudeck’s disease. However, the majority of those affected experience pain, but not restricted movement.
A multimodal treatment for complex regional pain syndrome can lead to good results within months. It is crucial to maintain the patient’s will not to be controlled by the often unexplainable disease. The mobility of the affected body region should be preserved. At the same time, painkillers are sometimes used and, thanks to psychotherapy, the patient learns measures that help him to deal with the condition. Therapy can sometimes take years.
A chronic and severe course, which provides those affected by Sudeck’s disease with a disability, is possible. In such cases, there is a loss of function in the affected part of the body and therapies are no longer sufficient to restore function.
Various studies have shown that the risk of Sudeck’s disease can be reduced. After a wrist fracture, daily intake of vitamin C supplements can reduce the risk of developing the disease. Early mobilization after a stroke can also reduce the risk of Sudeck’s disease.
The optimal pain treatment provides a combination of centrally and peripherally acting methods. Invasive pain pumps offer a high level of autonomy, have almost no potential for addiction and make everyday life easier for those affected. This reduces psychological stress and minimizes pain perception. Patients, however, must first learn how to use it. Non-drug pain therapies also increase well-being, counteract relieving posture and contractures and ensure relaxation. These include cold and heat applications, massages, TENS, gentle positioning, relaxation exercises or aromatherapy.
In most cases, follow-up care is aimed at those affected and their families. Because only with the help of a combined therapy can sufferers deal with their pain better, verbalise their fears and thus gain tolerance from their environment. Aftercare can include body therapy, for example, in which pain-adapted methods of coping with work or mobility are learned.
Psychological therapies also help sufferers to cope with pain and practice healthy behavior while integrating the pain. Additional therapies such as music, dance, art or autogenic training help chronic pain patients to relax and reduce stress, which is reflected in reduced pain perception.
In an occupational therapy practice, patients learn how to use aids in everyday life in order to be able to make life easier. Physiotherapy supports the lymphatic drainage and prevents lymphatic congestion, which can otherwise lead to increased pain and reduced mobility.
You can do that yourself
If Sudeck’s disease is detected early, the symptoms can be alleviated by drug treatment. The patient can support the medical therapy by taking natural painkillers.
Naturopathy offers effective preparations, such as St. John ‘s wort capsules or teas made from African devil’s claw. Various creams are also used to alleviate hypersensitivity. The pain can be reduced by targeted massages. Mobility can also be relieved with pressure massage and acupuncture. In consultation with the doctor, methods from Chinese medicine can also be used to alleviate the symptoms. Chronic pain can be relieved with the help of relaxation techniques. The attacks often subside through calm inhalation and exhalation and the use of essential oils.
Since Morbus Sudeck can also impair mental health, it is always recommended to be accompanied by a therapist. The patient should also consult closely with the doctor responsible, especially in the case of a severe course or a poor general prognosis. People in whom Sudeck’s disease is already well advanced must always be treated in a specialist clinic.