The main difference between CRPS type 1 (RSD) and CRPS type 2(Causalgia) is that Type 2 is caused by a proven nerve injury. Recent research (see Medical Updates) shows CRPS Type 1 is nerve injury and NOT a somatic disorder. The symptoms of both diseases are identical.
There are four cardinal signs that indicate CRPS Type 1 and 2:
PAIN is constant and characterized by burning. The non-relenting pain is enhanced with every movement.
SWELLING is sometimes localized, but often unrelenting, and progressive. Swelling intensifies the pain and promotes stiffness which can be the beginning of atrophy and deformity.
When tissue is injured or inflamed, excess fluid enters the tissues from damaged blood vessels within these injured tissues. If the veins cannot remove all of this fluid, the part swells (edema). However this swelling is usually only temporary, because the tissues heal and the blood vessels no longer leak excessively.
Swelling is one of the symptoms of RSD. Early in the course of the disease, this inflammatory process causes edema. The swelling in RSD may exist far longer than it would take normal tissue to heal because RSD:
– prevents healing
– causes constant inflammation
– may cause dilation of the arteries which will cause more fluid to leak, and may cause the veins to contract, which also prevent the normal removal of non-protein fluid from tissues.
– It is pretty easy to see that the edema of RSD may last for long periods of time.
STIFFNESS, like swelling, is progressive resulting in less motion of the joints, which again, results in increased swelling and pain This in turn, can produce further deformity and joint changes.
DISCOLORATION indicates circulatory changes that diminish the nutrition of the tissues of the skin, ligaments, bones and tendons. The result is thin, shiny skin, pencil-like fingers and changes in ligaments. This further contributes to stiffness and pain. CRPS in the upper extremities had been classified in the following five ways, based on the location and intensity of symptoms.
RSD & CRPS Frustration
RSD/CRPS is frequently dismissed by health professionals for many reasons including:
They don’t understand the diagnosis and/or they are not familiar with the disorder.
They understand the diagnosis but lack experience in how to treat it properly.
Many think that the client is pretending to be ill.
RSD/CRPS is thought to be hopeless and there is no cure. (There is hope!)
RSD/CRPS is purely psychological and that it is not a medical condition, i.e. “It’s all in your head”. (This is a myth.)
Many people who work within the health care system dread accepting a client with RSD because effective treatment requires an ongoing, almost daily assessment of the condition to develop the proper regimen. It is far too time consuming for most clinics to adequately care for RSD clients.
Due to the nature of RSD, the condition can quickly change for better or worse for reasons that are not fully understood. Therefore it is necessary to schedule evenly spaced treatment sessions in order to benefit the client.
The health care provider must address the plan of care very carefully once the diagnosis is made and must thoroughly customize therapy for each client. All individual characteristics (psychological, social, physiological) must be taken into account during therapy.
Communication between the family members, health professionals, and the client must be clear, ongoing and become well established. It is common for the client to have failed in a previous program if a positive, creative, caring relationship was not established. If either the client or the therapist senses a communication problem, it is far better to acknowledge that another clinician may be of greater benefit to the client’s progress.