Complex regional pain syndrome (CRPS) - also known as Sudeck's disease after the person who first described it - is defined by doctors as persistent and severe pain, usually in the leg or arm, often accompanied by limited mobility of the affected limb. Find out more here about the cause, symptoms, therapy and treatment options, prognosis and self-help services.
Here you will find all the important information as well as highly qualified Sudeck's disease specialists.
Complex regional pain syndrome, CRPS for short, is also known as "Sudeck's disease" or "sympathetic reflex dystrophy". It manifests itself in the form of (permanent) pain, primarily through
The disease mainly affects the hands or feet.
With a frequency of 2-15%, CRPS occurs after injuries to the arms or legs. This risk exists above all after
Occurrence after minor injuries, such as cuts or insect bites, is rarer.
Women are affected two to three times more frequently than men. CRPS mainly occurs between the ages of 40 and 70, rarely in childhood and old age.
The cause of CRPS is still not fully understood. A combination of
These various processes are responsible for the wide range of symptoms. However, not every symptom occurs in everyone.
Endogenous inflammation is normal. It always occurs after tissue damage and is regulated by the body. In CRPS, however, this inflammatory reaction is more pronounced. The body can no longer control it.
However, a healing reaction can still occur even after months or years.
A distinction is made between CRPS I and CRPS II. In CRPS I, there is no detectable nerve lesion. In CRPS II, there is damage to the affected nerves. However, this distinction is irrelevant for treatment. The therapies are identical.
The symptoms can change over the course of the disease. Central changes (spinal cord and brain) can occur later in the course of the disease.
The acute phase of the disease is characterized by excessive and prolonged inflammation. It usually lasts up to six months after the injury.
The visible symptoms include
Other symptoms include impaired mobility, for example
be reduced. Strength is often reduced.
The pain may be permanent or load-dependent. The intensity of the pain can fluctuate during the course of the day. Pain can also be exacerbated by external factors such as
can occur. Touch can also feel numb or tingle like ants. Some patients have the feeling that the affected body part no longer belongs to their body. As a result, new injuries can occur, for example, due to bumping.
Symptoms of CRPS on the hand © CRPS Network, courtesy of Ms. M. Burk.
The diagnosis of Sudeck's disease is made clinically. Imaging procedures such as X-ray, MRI and bone scintigraphy are not necessary. The doctor diagnoses CRPS on the basis of certain symptoms and by ruling out other diseases.
The most important diagnostic tool is the Budapest Criteria, which can be found in the CRPS guideline.
Persistent, excessive pain that can no longer be explained by the original injury.
The affected person must have at least one symptom from each of 3 of the following 4 categories:
At the time of the medical examination, the affected person must have at least 1 symptom from each of 2 of the following 4 categories:
Symptoms of CRPS on the foot © CRPS Network, courtesy of Ms. M. Burk.
There is no cause-related (causal) therapy for CRPS, as the cause is unknown. Treatment is therefore based on the symptoms present and the CRPS guidelines. Multimodal pain therapy is recommended.
Here, pain therapists work together with experts from the fields of occupational therapy, physiotherapy and psychotherapy.
Anti-inflammatory therapy is important in the acute phase. Cortisone is mainly used here as long as inflammatory symptoms are still present. This treatment should not be carried out for longer than a maximum of 6-12 months.
Pain therapy usually consists of the temporary administration of
together. These include, for example, medication against
Surgery should only be performed in specialized centers if other therapies are not effective enough. In the case of CRPS, interventions of all kinds should be considered critically, provided they are not life-threatening. They can also cause a recurrence of the disease in another limb.
One of the most important components of therapy is active physiotherapy and occupational therapy. Complete immobilization should be avoided. Exercises to improve strength and mobility should also be carried out at home.
Active exercises can lead to a temporary increase in pain. In the long term, they are important for maintaining function.
Mirror therapy is one therapeutic measure. In CRPS, areas of the brain that supply the diseased extremity become smaller. The body schema is lost in the process. In mirror therapy, the brain is made to believe that the affected limb is moving without pain. This stimulates the neglected brain region.
Measures such as
can also provide relief.
Sudeck's disease is an extremely stressful pain disorder. Supportive psychotherapy is therefore always advisable. It helps those affected to cope better with the changes in their lives.
Certain psychological stresses ("stressfull life events") can have a negative impact on the course of the disease. This is also the case with other chronic pain disorders. However, they are never the cause of CRPS.
CRPS is a pain disorder that has considerable psychological consequences for many sufferers. Some sufferers show excessive anxiety and protective behavior. Others, on the other hand, try to hide the disease and not let it show.
Even in the first few months of the illness, sufferers notice severe physical and mental exhaustion. They often complain of
It is assumed that psychological symptoms are the result and not the cause of CRPS.
Psychotherapeutic treatment is divided into several phases.
In the first phase, the most important goal is to provide information about the clinical picture tailored to the person affected. Psychotherapy also has the task of absorbing the fear, anger and helplessness caused by the sudden physical and psychological changes.
From one day to the next, those affected are restricted in almost all activities of daily life. This affects not only professional and social activities, but also everyday tasks such as
At the same time, their social environment often shows little understanding for their limitations. This usually leads to them withdrawing socially.
For psychological stabilization, the following have proven particularly effective
have proven effective.
The medical, physiotherapeutic and psychotherapeutic measures should always be coordinated with each other. They are usually combined in a multimodal pain therapy.
In the second phase, techniques should be taught that help those affected to
In the third phase of treatment, the patient learns to
In addition, the therapist works with the patient to develop realistic plans for professional and private reintegration. These concerns should also be discussed in psychotherapy so that competent contacts can be found.
The "CRPS Netzwerk gemeinsam stark" is an association of all CRPS self-help groups in Germany, Luxembourg, Switzerland and Austria. It provides information on the disease, treatment options and specialists.
In addition, regional groups offer an exchange via the Internet and at regular meetings.
CRPS is a long-term disease and requires a lot of patience. In rare cases, chronic CRPS can lead to
disability. In general, the earlier the condition is recognized and treated, the better the prognosis. However, progress is also possible after a longer period of illness.
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