Introduction
During the 17th and 18th centuries, many researchers tried to describe this condition but found it difficult to contextualize it. It was described for the first time in 1864 by Mitchell, who coined the term causalgia, meaning burning pain. It describes a painful condition associated with sensory disturbances following a severe nerve injury. The International Association for the Study of Pain (IASP) developed and termed the condition a complex regional pain syndrome.
What Is Algodystrophy?
Algodystrophy, also called complex regional pain syndrome (CRPS) or reflex neurovascular dystrophy, is a term used to describe a variety of disorders characterized by spontaneous and continuous pain associated with disability and loss of quality of life. It may occur at any age but is usually rare in children and adolescents. The incidence is seen in more elderly individuals above 70 years of age, especially women. The upper limb is more affected compared to the lower limbs. Algodystrophy can be divided into three stages; acute stage (associated with inflammation), dystrophic phase (progressive reduction of edema), and atrophic phase (skin atrophy and contractures).
What Are the Causes of Algodystrophy?
The causes of algodystrophy are not completely understood. Still, they are believed to be due to inflammation or immune reaction in the peripheral or central nervous system.
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In most cases, algodystrophy results from damage to the sensory and autonomic nerve fibers (nerve fibers that transmit various sensations such as pain, temperature, itch, etc.) due to injury to the limb.
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Displaced bone fractures or a tight cast can also damage the nerves resulting in algodystrophy.
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Surgical sutures and scarring.
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Damage to the connective tissues due to sprains or strains can result in excessive movement of the joint, resulting in overstretching of the nerves.
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Injury to the nerves due to cuts, burns, or bruises can also cause algodystrophy.
What Are the Signs and Symptoms of Algodystrophy?
Some of the signs and symptoms of algodystrophy include:
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Burning pain and swelling. Pain may be progressive and worsens with time.
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Stiffness of the joints.
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Sensitivity to touch and cold, and pain or numbness.
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Difficulty in the movement of the affected part.
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Changes in skin color (pale purple or red), temperature (warm compared to the unaffected limb), and texture may be thin and shiny and sometimes associated with excessive sweating.
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Changes in the pattern of nails and hair growth may be rapid or no growth.
What Are Some of the Risks Associated With Algodystrophy?
Algodystrophy can occur due to long periods of immobilization; some risk factors associated with algodystrophy include:
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Inflammatory diseases such as asthma or autoimmune diseases can elevate the levels of cytokines and result in the symptoms of algodystrophy.
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Chronic conditions such as diabetes can lead to peripheral neuropathy (damage to the nerves situated outside the brain and spinal column), which makes the nerves less resilient and unable to repair.
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Due to previous chemotherapy treatment.
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Smoking can cause difficulty in regenerating nerves.
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Studies have demonstrated family clusters of algodystrophy; hence, genetic predisposition can also affect the patient’s ability to recover from an injury.
How Is Algodystrophy Diagnosed?
Algodystrophy is a rare condition, and as no specific test is available, it is often difficult to diagnose algodystrophy. It is usually diagnosed by a thorough medical history, signs and symptoms, and a physical examination. The patient usually reports a severe intensity of pain; in case of a recent injury or any surgical procedures, the doctor will perform a physical examination to examine a change in the appearance and texture of the skin and a rise in the temperature of the affected area.
Imaging tests such as ultrasound or magnetic resonance imaging (MRI) can be advised to diagnose the nerve injury. Electromyography can also be recommended in some cases to rule out pain due to other causes of neuropathy.
How Is Algodystrophy Managed?
Algodystrophy can be managed only by supportive treatment, and the main aim of the treatment is to reduce the pain and other symptoms and restore the normal function of the affected limb and improve the quality of life. Early initiation of the treatment helps to treat the condition, as the pain may worsen with time, and the affected limb may become stiff and difficult to treat. Psychotherapy and rehabilitation treatment are recommended in cases of algodystrophy in children. Some of the methods to manage algodystrophy include:
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Medications: Pain-relieving medications are prescribed depending on age and other existing medical conditions. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as Ibuprofen, Naproxen, and Acetaminophen can be useful. Topical analgesic creams, lignocaine patches, or botulinum injections (botox) can be recommended. In some severe cases, medications such as Gabapentin, Pregabalin, Amitriptyline, or bisphosphonates such as Alendronate may be prescribed.
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Physical Therapy: Physical exercises and techniques may help reduce the pain and improve the movement of the affected limb.
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Lifestyle Changes: Management of conditions such as diabetes and quitting smoking can improve blood circulation and prevent damage to the nerves.
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Psychosocial or Behavioral Therapy: Anxiety, stress, and depression can worsen the pain, and psychotherapy can help to identify the thoughts and behavior and help in the management of algodystrophy.
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Alternative Pain Management Therapies: Some of the alternative therapies, such as acupuncture, Reiki, hypnosis, and chiropractic, may help in the management of pain. In case of no improvement is observed, it may be a severe case of algodystrophy and would require some invasive treatments such as:
- Sympathetic Nerve Blocks: Nerve blocks such as the lumbar sympathetic block (injection of anesthetics next to the spine) blocks the sympathetic chain, which transmits the pain signals from the lower limbs to the brain and spinal cord. Stellate ganglion block may be administered on the side of the neck in cases of algodystrophy of the upper limb.
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Peripheral Nerve Stimulation: A stimulating electric impulse can be placed near the major nerve of the affected limb, which interferes with the pain signals and promotes healing.
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A Trigger Point or Tender Point Injections: Local anesthetics with or without glucocorticoids may be injected into the trigger points in muscles of the affected limb, which can help treat the initial stages of algodystrophy.
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Stimulation of the Spinal Cord or Dorsal Root Ganglion: Implantation of pulse generators beneath the skin of the abdomen or buttocks and wires near the spinal cord sends low electric impulses and interferes with the pain signals being sent to the brain. In the case of stimulation of the dorsal root ganglion, smaller wires are implanted but are more targeted and highly efficient as it targets small relay areas which control the pain signals sent from the peripheral to the central nervous system.
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Ketamine Infusion: Low doses of Ketamine can be administered intravenously for three to five days which works by blocking the receptors which cause or worsen the pain.
How Can Algodystrophy Be Prevented?
Some of the measures to prevent algodystrophy include:
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Smoking can impair nerve regeneration; hence quitting smoking increases the chance and speed of recovery.
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Effective management of conditions such as diabetes through proper medications and a healthy lifestyle, regular physical exercises can help improve blood circulation, and nerve damage can also be prevented.
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The use of compression stockings or sleeves can limit the development of swelling, especially when standing.
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Stress, anxiety, or depression can worsen the symptoms of algodystrophy; psychotherapy can help relieve the symptoms and contribute to early recovery.
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Some studies suggest that the intake of a vitamin C-rich diet or supplements prior to surgery promotes healing and prevents damage to the nerves.
Conclusion
Algodystrophy, also called complex regional pain syndrome (CRPS), is a neurological condition mainly affecting the upper limbs and characterized by severe pain, swelling, difficulty in movement, and skin changes. The exact cause of the condition is unknown, but it usually occurs following an injury to the nerves due to fractures or damage to the connective tissues. Algodystrophy can be managed by supportive treatment with the help of medications, psychotherapy, and lifestyle modifications.
