Post-injury Chronic Pain

Introduction

What is post-injury chronic pain?

After an injury such as a bruise, sprain or fracture of the arm or leg, complete healing and recovery occurs after a few weeks. In a small percentage of people, pain may persist at or around the injured site even though the skin or deeper tissues appear normal. This painful condition is called Complex Regional Pain Syndrome (CRPS). In some instances, the injury leading to CRPS may be so minor that patients sometimes cannot recall the injury or event that triggered CRPS.

Symptoms

How does CRPS present?

CRPS usually affects one or more extremities, but may affect any part of the body. Pain is constant, sharp, burning, pricking or shooting in nature. There may be associated numbness and increased sensitivity to touch. Wearing socks over the affected foot can be extremely painful and intolerable. The affected arm or leg may even appear warm and flushed or cold and blue. Swelling and loss of hair can also occur. In chronic cases, X-RAY may also demonstrate osteoporosis after one to two months from the onset of CRPS.

Treatment

How do we treat CRPS?


The objectives of CRPS treatment are relieving pain and restoration of function of the affected limb. Your doctor may prescribe pain medications that work specifically on nerves to reduce pain signals to the brain.

When medications fail to control pain, your pain specialist may perform one or a series of nerve blocks with local anaesthetics for treatment. A series of blocks can be performed.

Physical and occupational therapy play an integral role in CRPS treatment. The aim is to maintain or improve function and mobility of the affected limb. Following adequate analgesia, therapy focuses on range of motion exercises, strengthening, and aerobic conditioning.

CRPS patients that have not responded to drugs or nerve blocks may be suitable candidates for spinal cord stimulation. Spinal cord stimulation involves placement of electrical wires over the spinal cord. When an electrical current is stimulates the spinal cord, pain signals to the brain are interrupted.