Reflex Sympathetic Dystrophy Syndrome
Complex Regional Pain Syndrome
Difference between Peripheral Neuropathy and CRPS
What is the Difference between Peripheral Neuropathy and Complex Regional Pain
by Elliot T. Udell, DPM
In podiatry, when we talk about peripheral neuropathy we generally are referring
to conditions that affect the local nerves in the lower extremity. This is distinct from
conditions that affect the brain and/or spinal cord Diabetes is one of the leading causes of
peripheral neuropathy. Research shows that diabetes affects the tiny nerves and small
arteries in the area where the patient is experiencing pain. The pain is generally described
as "severe burning" or "pins and needles" and is generally worse at night. Months or years
later, this pain may lead to numbness indicating the presence of far greater nerve damage,
and in such cases we have to be concerned with the development of ulcerations.
Complex regional pain syndrome (CRPS), also known as reflex sympathetic dystrophy
syndrome (RSD), presents quite differently. Because my practice is focused on patients
with severe foot and ankle pain syndromes, I treat people with both peripheral neuropathy
and CRPS/RSD. Hence, I am well aware of the overt as well as subtle differences
between these conditions.
People with CRPS/RSD generally present with a history of an inciting injury, which may
be a sprain, fracture or even surgery (many elective surgical procedures can lead to
CRPS/RSD). They also present with severe pain, which is far more intense than
that experienced by people with peripheral neuropathy. The pain is so severe at times
that even air blowing on the area can cause a person to wince in distress. People who
have CRPS/RSD can also present with other symptoms generally not associated
with peripheral neuropathy, such as sleep disturbances and clinical depression. The
depression results from the physiology and anatomy of the sympathetic nervous system
synapses rather than purely from an emotional reaction to the pain. Moreover, we
commonly see skin problems associated with CRPS/RSD, such as edema and small shiny
plaques that are exquisitely painful.
Another significant difference is the tendency of non-treated CRPS/RSD to progress to
the opposite extremity and to the upper limbs. A glance at the anatomy of the
sympathetic nervous system, which runs parallel up and down both sides of the
spinal cord with perpendicular crosses from right to left, may explain why this
illness can easily progress to other parts of the body. Also, CRPS/RSD patients
often have both spasms of the muscle and progressive muscle weakness.
Untreated, this muscle weakness can lead to atrophy and loss of use of the
extremity. Such extensive and debilitating muscle weakness, as well as atrophy, is
not common in peripheral neuropathy.
Because the anatomy and physiology of the symptoms are different, so are the treatments
of these conditions. The treatment of CRPS/RSD is complex; we use intense physical
medical modalities and many different types of oral pain medications and antidepressants.
Each condition is different, challenging, and time consuming, but the rewards of seeing
patients leave their wheel chairs and crutches and return to work and school makes any
effort we put into working with these people emotionally rewarding.
Dr. Elliot Udell specializes in pain management of the foot and ankle. He is in practice in
Hicksville, New York. He is currently president of the American Society of Podiatric
Medicine and is on the board of the American Society of Podiatric Dermatology. He is
board certified in Podiatric Primary Care as well as Pain Management. He lectures at
medical seminars throughout the US as well as in Europe.
He can be reached at Suite 206, 120 Bethpage Road, Hicksville, New York 11801
Tel: (516) 935-1113, e-mail Elliotu@aol.com