Complex Regional Pain Syndrome: What is Algodystrophy?
Algodystrophy is a very rare chronic disease. Also called Complex Regional Pain Syndrome, the characteristic symptom with which it presents is a very intense pain, felt by the patient in one of the four limbs, so severe that it can limit the individual’s daily life
The upper and lower limbs are the anatomical areas most frequently affected because they are subjected to the most trauma.
The scientific community has, in fact, recognised algodystrophy as post-traumatic dystrophy, since it develops, in most cases, as a result of fractures or damage to surrounding soft tissue.
The perceived pain is more intense than what the patient should normally feel from the trauma they have suffered.
Research shows that the sex most affected by algodystrophy is female and that patients are mostly between 50 and 70 years old.
Algodystrophy: the different types
To date, four different types of dystrophy have been identified, classified according to the underlying cause and how many limbs are affected.
If algodystrophy II (or Complex Regional Pain Syndrome II) includes all those situations that are preceded by an injury and subsequent irritation to the peripheral nervous system, algodystrophy I (or Complex Regional Pain Syndrome I) includes those patients in whom the manifestation of this pathology is not related to trauma that may have affected the peripheral nervous system.
Algodystrophy may be unilateral if it affects and develops on only one limb, or bilateral if both upper or lower limbs are affected.
Symptoms of algodystrophy
There are still many doubts surrounding this condition.
By observing different patients, it has been possible to draw up a list of typical symptoms:
- Pain and burning in all or part of the limb. It is usually intense, stinging and grows in progression until it becomes debilitating. Although it remains the main manifestation, it is very subtle because it can last for a few days, but also for weeks, and it can subside and disappear on its own and then suddenly return in a more intense manner.
- Allodynia. The subject experiences pain even from mild stimuli that are not normally painful.
- Hyperalgesia. The perception of pain in the subject is disproportionate to the intensity of the stimulus felt.
- Usually pain is associated with the presence of oedema, which leads to stiffness and swelling of the affected area.
- Weakness in the affected limb with which tremors and muscle spasms may be associated.
- Difficulty in movement of the affected joint.
The affected arm or leg may become very fragile, even to the point of developing osteoporosis.
As a result, the individual may be prone to frequent fractures, cuts, abrasions and sprains.
The presence of oedema or a traumatic event affecting the peripheral nerves may affect the blood circulation of the limb, which may have sweating problems (hypo/hyperhidrosis).
Skin changes may be observed in the affected limb.
The epidermis becomes reddened, hot and dry or cold and cyanotic.
Another typical symptom is keratin changes, with hair and nails growing slower or faster than normal.
In cases where algodystrophy is associated with an infection, skin ulcers, muscle atrophy and frequent contractures may appear, which have a considerable impact on walking.
Fever may also be present.
In the vast majority of cases, pain appears within a month of the traumatic event.
For algodystrophy, it is not possible to identify a clear-cut trigger.
Some studies suggest that it may be caused by the simultaneous malfunctioning of several apparatuses and systems of the body, in particular the central nervous system (encephalon, spinal cord) and peripheral nervous system (nerves), the cardiovascular system and the immune component.
The hypothesis is based on careful observation of patients with algodystrophy, in whom dysfunctions have been detected in precisely these systems.
It appears, for example, that the ability to perceive stimuli is impaired in the peripheral nerves.
Although the causes remain a mystery, risk factors can be identified.
Algodystrophy is frequently associated with bone fractures, burns and burns, cuts and sprains, but also contusions, crush injuries or invasive surgical treatments.
Once again, the mainly post-traumatic nature of the disorder is thus confirmed.
No particular genetic correlation has yet been found between individuals with algodystrophy.
Thus, there is no certainty as to whether or not it is hereditary and anyone with parents with algodystrophy is an individual at risk.
Algodystrophy: how is it diagnosed?
Establishing a definite diagnosis of algodystrophy is still complicated: as it is a rare disease with still partially unknown causes, the diagnosis is made by exclusion and following a careful evaluation of the symptoms and the course of the disease.
Moreover, there is no diagnostic test that is unambiguous and specific, so it is not easy to detect it when the symptoms are very similar to those of other diseases.
It remains advisable to undergo a medical examination as soon as intense and constant pain is experienced in one of the limbs, which not only prevents the performance of daily activities, but is also disproportionate to the trauma previously suffered in the same limb or if a precise cause is not recognised.
The medical examination involves taking a thorough anamnesis to assess the patient’s medical history, present and past symptoms.
For example, experiencing intense and persistent pain in a limb can be an alarm bell, as can noticing disturbances in sensitivity, or oedema resulting in a change in the colour of the epidermis.
Blood tests are usually prescribed to exclude other pathological conditions, e.g. of an infectious nature.
The patient may undergo nuclear magnetic resonance imaging (MRI) to rule out problems with the bones, cartilage and soft tissues of the joints.
The same happens with an X-ray of the affected limb.
Thanks to biomedical imaging techniques, it is possible to detect signs of bone demineralisation, an indicator of chronic and advanced disease progression.
The specialist may opt for nerve conduction studies to assess whether and how the nervous system is involved in the problem.
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Algodystrophy: treatments and prevention
Algodystrophy is a disorder whose causes are still not fully understood.
The direct consequence is the lack of specific treatments to solve the problem.
Although it cannot be totally eliminated, there are certain treatments aimed at curing the symptomatology in order to reduce its intensity.
To date, symptom therapy is based on three different types of intervention.
It includes rehabilitation exercises to improve joint movement and circulation in the limb, the primary cause of pain.
It also improves the elasticity and strength of the muscles, so that the discomfort is alleviated and simple activities can still be performed.
Keeping active is recommended, even if the limb is painful.
Immobility only worsens the situation, leading, in the long run, to muscle atrophy.
It is important to try to reproduce at home what you have learnt during physiotherapy sessions, in order to reduce periods of immobility.
Pharmacological therapy relies on the action of different types of drugs:
- Anti-inflammatory NSAIDs (aspirin, ibuprofen), as they act on inflammation and reduce pain.
- Use of local anaesthetics in the form of creams, ointments, lotions to be applied on the painful limb and damaged skin.
- Take corticosteroids and opioids. Cortisone works by reducing pain, but it must be administered for very short periods of time, because it is burdened by important side effects.
- Taking antidepressants can be helpful in treating depression resulting from the disease.
- Pain-relieving injections near the spinal cord can be used to block the sympathetic nerve. They block nerve activity and reduce pain, if only temporarily.
- Sympathectomy. The surgical removal of certain nerve components can be performed with the aim of drastically reducing pain.
- Electrostimulation of the spinal cord involves placing electrodes on the spinal column. Once the spinal cord is stimulated, the pain felt should decrease considerably.
Algodystrophy can have psychological implications for sufferers.
As a consequence of the intense pain experienced, which, in most cases, turns out to be chronic, the affected person may develop more or less severe forms of anxiety and depression, combined with a strong sense of discomfort at not being able to perform even the simplest daily actions.
It is important and advisable to set up a cognitive-behavioural psychotherapeutic course.
It may also be useful to attend support groups to reduce the discomfort and sense of loneliness.
This type of rehabilitation includes the practice of relaxation techniques that act on stress and anxiety and on the ability to control pain.
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