Complex Regional Pain Syndrome usually begins with an injury, and depending on what type of injury the sufferer received, it will place them into one of the three "types" of CRPS. Being placed into a type generally does not impact treatment, although in some cases it can.
CRPS Has Three Types;
- Type-1 - wherein there is no direct injury to a nerve. This can include soft tissue damage such as blunt force impact to the surrounding tissues, a sprain to the ligaments, bruise, or simply by stubbing a toe. This type is also commonly referred to as Reflex Sympathetic Dystrophy (RSD) which was the disease's former name prior to 1994 when the IASP (International Association of Pain Study) changed its name to cover a broader group.
- Type-2 - wherein there was a direct injury to the nerve such as surgery, incision, amputation, laceration. This was previously called Causalgia prior to 1946 when it was changed to RSD.
- Type-NOS (Not Otherwise Specified) - When the IASP (aka Orlando) converged for the first time in 1994 and brought together RSD and Causalgia, combined with the Budapest Criteria, but this left a group of people that would be otherwise, undiagnosed as the Budapest Criteria was more advanced than the Orlando criteria. Therefore, the NOS category was created to include that small group of people who were previously diagnosed to allow them to maintain their diagnosis. Read more...
Enter the Sympathetic Response System
Once the pain receptors signal that there is an issue, the process begins. As soon as the pain receptors notice pain, they notify the sympathetic nervous system (SNS). The sympathetic nervous system has a unique role to play with its neurotransmitters in regulating inflammation. It is also what is in charge of the infamous "fight or flight" response as it is integrated with so many systems in the human body.
It is designed to respond and react, to a dangerous situation; like being chased by a bear, responding to a burglar, maybe when a police car pulls behind you when you are doing 10 over, and when you are injured.
The SNS is an amazing tool that our bodies use to warn our brain, us, of impending doom so that we can focus in on that dire circumstance only, and seek safety. It gives us two choices: fight or flight.
For those of us with CRPS, reading that now, it's not so far-fetched calling ourselves WARRIORS now is it? We too are given to choices; fight or die.
The SNS in Perfect Equilibrium
This amazing SNS system that reacts to dangerous situations, works with several systems, including the immune system, the neurological system, the brain, the vascular system, the stomach and digestion and so on. It is like the timing belt of a vehicle which keeps everything running in perfect time with everything else so that our bodies all function in a steady-state of equilibrium.
It is also working in perfect harmony with the hypothalamic-pituitary-adrenal (HPA) axis, the vagal nervous system (VNS) and the sensory nervous system and is linked with vasoconstriction and vasodilatation.
For most healthy people, when injured, because of this perfectly equalized system, the process is a very tuned, and generally timed, the cycle to heal the wound and get through the steps of "Inflammation" generally takes 5-7 days to complete (barring that there are no infections or outside influences that can cause the cycle to delay). But, with people suffering from CRPS, for whatever unknown reasons, the SNS and inflammation are tied together, and people suffering from this disease get "caught" in this cycle.
The "steps" are really the Inflammatory Response
- Calor - Redness
- Mototrophic (difficulty of movement
The Cycle that Causes CRPS
So how do some people "get better" and heal from their wounds, and others just...don't?
Life just can't be that unfair. There has to be a scientific reason. While we don't know why it is today, we just know that there is something wrong in the nerves and the way that they are carrying the pain signals to the brain, and because of the direct link to migraines, we know that there is something wrong with how the brain reads pain.
- There is an injury to a limb, or really any body part - as all body parts are connected to the nervous system.
- Pain receptors send signals to the sympathetic nervous system
- The Brain is notified via the sensory nerves that there is an injury
- The Brain sends a signal to the Sympathetic Nervous System (the SNS has bi-directional communications with the brain at all times)
- The SNS then checks in with the originating injury (yep, it has pain!)
- Which causes the "Inflammation Response (Below) to kick in.
- The blood vessels spasm, increasing the pain (causing the wonderful discoloration & swelling).
- Inflammatory Response causes the limb to swell - even in areas that are not where the injury actually is.
- At this point, the cycle splits to do two things - it goes back to #4 effectively starting the cycle and the cycle going AND goes to #10
- Resulting in what we call CRPS which creates NEW symptoms that only those with CRPS would notice.