Understanding Complex Regional Pain Syndrome and Erythromelalgia

These are 2 relatively uncommon conditions which may appear somewhat similar. Dr Chernish has had positive experiences in treating both conditions with acupuncture.

Complex Regional Pain Syndrome (CRPS)

CRPS, formerly known as Reflex Sympathetic Dystrophy (RSD), is a rare syndrome of localized pain and stiffness which develops after trauma, often a fracture of the hand or foot.

In the weeks after an injury, instead of improving, pain and stiffness of the affected extremity get worse. 

Excruciating pain may develop, including burning pain caused by normally non-painful stimuli such as light touch (known as “allodynia”).

If the condition is left untreated, swelling and redness of the joint or extremity may develop, along with increasing stiffness, intensified and more diffuse pain, and increased sweating of the area.

In the late stages of CRPS, the skin of the affected area becomes shiny and tight, nails may become brittle, and there may be increased hair growth in the area.

The cause of CRPS following trauma is not known.  Since CRPS is a clinical diagnosis and there is no single test that proves or disproves the diagnosis, there can be some disagreement over who exactly has this condition. The treatment for CRPS is to treat pain and encourage movement of the stiff and painful areas, prevent chronic pain and permanent stiffness, weakness, functional impairment, and deformity.

Standard medical therapy has changed over time and has included the gamut of oral medications, injections, nerve blocks, injections with assisted movement, physiotherapy, etc.  The treatment is usually intensive and may continue for weeks or months. Clinical trials have been of varying methodological quality.

There is not full agreement in what is the standard of care for treatment of this condition.  Acupuncture has a long history of traditional use for this type of pain with a favourable risk-to-benefit ratio and a reasonable cost.

Since this is one of the few painful situations that one can see, Dr. Chernish has included some pictures which he uses for teaching in the undergraduate Pain Curriculum at the University of Manitoba Medical School.

Patient with Complex Regional Pain Syndrome (CRPS), previously known as Reflex Sympathetic Dystrophy (RSD)

Erythromelalgia

Erythromelalgia is a condition in which the extremities, usually the feet, become red, swollen, and hot. It may appear similar to CRPS but there is no history of trauma. It usually occurs in 2 extremities, or more rarely in all 4. Stiffness, atrophy of the skin, and changes in sweating and hair or nail growth are absent.  There is no standard medical therapy, but therapies have included various injections or blocks, and medications that control arterial blood flow to the extremities.  This is not always successful. The treatments have to be continued usually lifelong and have their own set of side effects and costs.

Dr Chernish has found that this condition may respond well to acupuncture treatment with long-lasting results.

Erythromelalgia Day 1

Erythromelalgia Day 7: After 2 Acupuncture Treatments

Erythromelalgia Day 14: After 4 Treatments

To summarize, there is no gold standard of medical treatment for CRPS or erythromelalgia.  Acupuncture offers a long history of traditional use for these conditions, and the treatment is expected to produce a full or partial remission improvement of symptoms so that continuous treatment is not required.

Dr. Chernish would be happy to answer any further questions on the subject.