Difficult-to-Diagnose Pain Condition Needs Early Intervention

Paula Abdul has been open about the difficult-to-diagnose pain syndrome she has been battling for 25 years.  

The former "American Idol" judge announced in 2005 that she has Complex Regional Pain Syndrome, in the hopes of bringing awareness to the obscure, often misunderstood, condition.   

According to a USA Today article published, she said after the announcement her occasionally hyper-animated behavior on the show was caused by her joy at finally being pain-free; she had found the right medication.  

CRPS is chronic pain that usually results from trauma to a nerve after an injury: falls, strains, sprains, burns or even bruises. Someone who has undergone surgery or had a stroke is also at risk.  

Fortunately, it is not very common; in my practice, only 8 percent of our patients have CRPS. While the condition can afflict anyone, including children and teens, it generally affects women in their 40s.  

There is no known cause of CRPS and it has gone by many names over the past 150 years. The USA Today article said it was first described by a doctor treating soldiers with cannonball injuries in the Civil War: Causalgia.  

It has had several other names since then, including algodystrophy, Sudeck's Atrophy, variable pain syndrome, shoulder-hand syndrome and more recently and perhaps the most common: reflex sympathetic dystrophy. There are two kinds of CRPS: Type 1 and Type 2.  

The leg, arm hand or foot are the most affected body parts. For example, if someone hurts his toe, the pain can radiate through the entire foot and leg even after the toe is healed.  

For some reason, the sympathetic nervous system gets the wrong signal and supports the painful response to the injury.   Unfortunately, there is no single test for CRPS. The diagnosis is based primarily on physical exam findings.  

The pain is often described as a sharp stabbing pain, electrical current or tingling sensation. Light touch or movement can be very painful for someone with CRPS. Also there are often changes around the affected area, such as a change in skin color, temperature, and excessive swelling and sweating. In some cases, it can attack the bone and muscle.

The prognosis is different for each patient. Some get relief if it is treated very early. (Treatments range from anesthesia injections to electrical stimulators implanted in the spine). If the diagnosis is delayed, the disorder is harder to treat and the condition may become irreversible.  

About Dr. Scott Gottlieb: Dr. Scott Gottlieb is a pain management expert and the founder of Gramercy Pain Management. He is the director of Pain Management at New York Eye and Ear Infirmary (NYEE) and has treated over 3,000 patients. Dr. Gottlieb is board certified in both pain management and anesthesiology. He has offices in both Manhattan and Montebello, N.Y. in Rockland County.