CRPS Type II - Detailed information about CRPS Type II

Injury to a nerve can lead to neural pain, also known as CRPS Type II (Comp lex Reg ional Pai n Synd rome Type II) or Cau salgia.

This condition is characterized by excruciating burning-hot pain of the involved limb, triggered or enhanced by even the slightest touch (Allodynia); sometimes the painful response may be in body parts distant to the site of injury (Synaesthalgia). Other triggers are optical or acoustic stimuli, dryness (Xerosalgia), heat, emotional stimuli or the mere imagination of pain (Sympsychalgia). In addition, poor perfusion and trophic skin changes (i.e. changes in skin growth and nutritional status) occur.

This painful response by slight touch shares a similarity to trigger mechanisms in Neuralgia. However, in CRPS Type II, pain distribution is independent of the area which the injured nerve supplies; it may even affect the contralateral limb (Alloparalgia).

3. Exaggerated pain response after mechanical stimulation (Hyperalgesia) or – in extreme cases – after simple tactile stimulation (Allodynia).

4. The pain does not necessarily coincide with the supply area (innervation area) of the damaged nerve.

5. The regional pain is accompanied by disturbances of blood perfusion (hypoperfusion) and increased sweat secretion. Edema (= swelling) may occur.

In accordance with the new nomenclature (= classification) of the International Association for the Study of Pain ca usalgia is classified complex regional pain syndrome Type II (see above).

The term “ca usalgia” for nerve pain emphasizes the characteristic burning nature of the pain, whereas CRPS incorporates additional symptoms. CRPS Type I is called Sudeck’s Atrophy.

In the acute or subacute phase Non-Steroidal Anti-Inflammatory Drugs (NSAID`s), e.g. Mobec® (long-acting, with gastric protection). The so-called COX-2 Inhibitors have demonstrated the best gastric protection, e.g. Parecoxib (Dynastat®) or Etoricoxib (Arcoxia®). However, this class of drugs appears to have an increased cardio-vascular risk, at least with prolonged use. It remains to be seen if Parecoxib and Etoricoxib will be taken off the market as has happened with other drugs of this class.

Sometimes the painful conditions can be controlled only with centrally acting (i.e. in the brain and/or spinal cord) analgesics (e.g. Tramadol®, Valoron N®). Carbamazepine (Tegretol®), an anti-convulsant drug, Gabapentin (Neurontin®) or Pregabalin (Lyrica®) are very helpful in the treatment of CRPS Type II. Pyridine Nucleotides (Keltican N®) are helpful with the sequelae of nerve damage in CRPS Type II.

In general, the long-term administration of analgesics should be avoided in CRPS Type II due to the risk of dependence and even addiction. Combinations with antidepressants that help patients distance themselves from the pain they are suffering (e.g. Doxepin, Maprotilin) but also neuroleptic drugs help reduce analgesic requirements in many cases.

Therapeutic Local Anesthesia (= treatment with a local numbing medication) in CRPS Type II:

Repeated nerve blocks (= numbing of nerves) with a long-acting local anesthetic, ideally continuously with a catheter, are helpful. With this technique a thin plastic tube is inserted in close proximity to a nerve bundle or the nerve involved. A standard catheter is inserted through a hollow needle, therefore no surgery or “cutting” is required. Subsequently, the local anesthetic is injected – entirely pain-free – several times a day, each time after the previous dose has worn off. In certain cases the administration of the local anesthetic through the catheter can be achieved with a small pump. In this case the local anesthetic is dosed such that muscle strength remains intact while the propagation of pain is being blocked thus enabling concomitant physical therapy. The fact that pain relief usually persists beyond the actual treatment can be explained with the concomitant effect on vegetative (sympathetic) nerve components which increases perfusion and subsequently improves local metabolism (this is a particularly important aspect of prolonged pain relief in CRPS Type II).

It has recently been recognized that this type of intensive nerve block therapy can extinguish the so-called pain memory in CRPS Type II.

Electrical stimulation can also provide relief in CRPS Type II. Transcutaneous (= via the skin) stimulation by low frequency generator through stick-on electrodes (TENS = Transcutaneous Electrical Nerve Stimulation) has the advantage that patients can treat themselves. The electrodes are applied as close as possible to the area of pain. Treatment effect can be optimized by changing the stimulation frequency and the size of the electrodes. Physical therapy is mandatory in the treatment of CRPS Type II.

Acupuncture must not remain unmentioned. Hypnotic modalities such as biofeedback or Jakobson’s Method of Progressive Muscle Relaxation are sensible additions to the comprehensive treatment strategy for chronic CRPS Type II, as well as learning techniques designed to help patients deal with chronic pain (Cognitive behavioral therapy).

What are the key advantages for pain management at pain therapy center Bad Mergentheim

An all inclusive offer of 144,42 Euros/day including drug treatments, physicians bills, accommodations and all meals.

Patients with CRPS Type II within the European Union may hand in their E - 112 of their individual health insurance company from their country of origin.

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