How is CRPS Diagnosed?
HOW IS CRPS DIAGNOSED?
CRPS can be diagnosed in a number of different ways. The best and most accurate way is a clinical diagnosis by a CRPS-educated physician, most often a Neurologist. Now we need a few definitions. What is a clinical diagnosis and what is a CRPS-educated physician? Lastly, are there other ways of diagnosing CRPS?
We need to answer the second question first. A CRPS-educated physician is someone who is up-to-date with the latest information on Complex Regional Pain Syndrome, as well as someone who has treated a number of CRPS patients successfully. The information in this field is changing rapidly and in the last few years has taken enormous steps forward. The more that is learned, the more it is shown that the best treatments for CRPS are the ones that are the least invasive. If a physician, or physical therapist is not familiar with treating CRPS patients then serious problems and setbacks can result.
A clinical diagnosis occurs when the patient presents himself to the physician. It is what the Doctor actually sees and hears in his office, not just reads in a test or report. To quote Sir William Osler: “Observe, record, tabulate, communicate. Use your five senses.... Learn to see, learn to hear, learn to feel, learn to smell, and know that by practice alone you can become expert. Medicine is learned by the bedside and not in the classroom. Let not your conceptions of disease come from words heard in the lecture room and read from the book . See, and then reason and compare and control. But see first.”
What does the Doctor look for? Not all patients will have the symptoms listed below at every stage of the disease, especially early on, but the physican should be alerted to:
- Pain that exists long after the injury has healed.
- Pain that is out of proportion to the injury sustained (these are two hallmarks of the disease that Doctors look for).
- Changes to the skin; color/texture, dryness, tightness, redness, skin rashes, possible sores, as well as an increase or decrease in sweating.
- The presence of a constant chronic burning pain. While there are some cases where there is no burning pain, it is rare.
- Spasms of the blood vessels and muscles.
- The existence of a prior injury that could have damaged a nerve.
- Use of casting, surgery difficulties, injury subsequent to the original incident.
- Lastly, they need to look for symptoms that the patient might not realize are significant and need to be shared with the doctor. These are changes that occur in the limbic system that cause:
- short-term memory loss
- difficulty concentrating
- difficulty finding the right word when speaking
- sensitivity to sound, vibration, smell, barometric pressure changes, and touch
There are other things to look for, obviously, but this gives you a basic idea. Are there other methods used to diagnose CRPS? Yes. Many are not very effective at truly diagnosing CRPS but are used none-the-less. Among these are thermography, MRI's, Cat-scans, X-rays, Bone-scans, accupuncture, EMG's, and many others. While some of these may show they presence of CRPS or some of its symptoms, often times it misses the disease altogether. It depends on the stage of the disease, the age of the patient, other diseases or problems the patient may be experiencing, how well medications might be working at the time of the test, as well as the skill level of the person administering the test. Unlike a typical and straightforward disease that is easily delineated and diagnosed with clearly defined symptoms, CRPS is a difficult diagnosis that takes a skilled and CRPS-experienced physician in a clinical setting where he can observe the patient's symptoms, sometimes over several visits, at different times of the day, and under different stress levels.
Just a side note. We came across this quote from Doctor John F. Dombrowski, a pain specialist recently and felt it was important to include it here.
"Just because you can't find the exact source of someone's pain doesn't mean they don't feel it," says John F. Dombrowski, MD, a Washington, D.C. pain specialist. No test can measure the intensity of pain, no imaging device can show pain, and no instrument can locate pain precisely. This doesn't mean pain can't be treated. "We don't need to know the exact cause of the pain to try to make it feel better."
DOES IT MATTER WHEN PATIENTS ARE DIAGNOSED?
Patients must be diagnosed and treated aggressively within the first six to twelve months of the onset of symptoms if there is to be any real chance of reversal. While some Doctors may quote a lower figure, all would agree that the odds decrease significantly every month after that, with the greatest drop after twelve months. Also, the younger the patient, the better their chances at reversal. Now there is new information available to Doctors to help them with their diagnosis. Typically, patients see between 5 and 10 Doctors before getting a correct diagnosis. According to a national survery conducted by American RSDHope, our survey came back with 55% seeing 7-10 doctors, 17% seeing 5-6 doctors and 14% seeing 3-4 doctors. That number is dropping slowly as the knowledge about CRPS increases.