Complex regional pain syndrome (CRPS), also known as reflex sympathetic dystrophy (RSD) is chronic pain in the nerves, arms or legs, back, foot, hands, or joints developing after trauma, infection, surgery, stroke, heart attack and even pregnancy. The pain is greater than would be expected from the injury that caused it and can last for years or be lifelong.

People with CRPS may experience a sensation of pins and needles, heightened sensitivity to pain, or uncomfortable tingling and burning. Other symptoms include bone loss, nervous system dysfunction, sweating, muscle twitch, loss of muscle, muscle spasms, contractions and skin and vascular changes. Depression, headache, joint stiffness, redness, stiffness, swelling, tenderness, or tremor are also common.

On the more technical side, a recent review article demonstrated that there are several underlying causes of CRPS including cytokine release, microglia activation, central sensitization, and autonomic nervous system dysfunction. Microglia cells are immune and structural cells that attach to nerve and brain cells and alter cellular activity and spinal sensory neuron excitability.

In the November 2015 issue of the LDN Research Trust newsletter, Dr. Leonard Weinstock wrote an interesting article on CRPS where he theorized that cytokine production produced by small-intestinal bacterial overgrowth (SIBO) and obstructive sleep apnea act as stimuli for ongoing CRPS symptoms.

Treatment usually consists of oral and topical medications, heat or cold therapy, physical therapy, and biofeedback. Topical medications are often preferred to oral because side effects (such as sedation with oral gabapentin) are reduced when the medication is applied topically to the affected area. Low dose naltrexone (LDN) has been administered to attenuate microglia activation and to regulate systemic inflammation which is commonly found in patients with CRPS.

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