Complex Regional Pain Syndrome is known by many names includingCausalgia, Reflex Sympathetic Dystrophy, Sudeck Atrophy, Shoulder-Hand Syndrome, Algodystrophy, Periferal Trophoneurosis, Sympathetically Maintained Pain and Posttraumatic Pain Syndrome. While CRPS is considered primarily a disorder of the limbs the head and neck is the fifth limb and has a tremendous effects on the upper limbs as well. Many severe types of chronic pain to the head including TMJ disorders, chronic sinus pain cervicalgia may involve CRPS as well.
In 1993 the International Association for the Study of Pain adopted CRPS specifically because it did not imply etiology or cause of the pain. CRPS type 1 replaced Reflex Sympathetic Dystrophy and CRPS type II replaced the term Causalgia.
The term Sympathetically maintained pain is no longer a requirement of CRPS. Having said that blocking of sympathetic and parasympathetic ganglia may be extremely effective for treating this condition.
The Sphenopalatine Ganglion (SPG) Block is the largest Parasyympathetic Ganglia and the only ganglia in the body that can be treated and/or blocked topically.
The SPG can be accessed thru the nasal cavity. This allows easy and safe self administration of anesthetic solutions at home by the patient. While it may not be universally successful it is miraculous CRPS cure in some patients. The SPG block was popularized in the 1980’s after the publication of the book “Miracles on Park Avenue” that described SPG Blocks being used for all kinds of chronic pain syndrome.
There are two injection sites that can be utilized for SPG Blocks, an intra-oral approach and an external approach.
There is also evidence that the Jaws, jaw joints and teeth can directly affect CRPS such as this article: The entire pubmed abstract is provided for your convenience. The article concludes “The results suggest that temporomandibular joint dysfunction plays an important role in the restriction of hip motion experienced by patients with CRPS, which indicated a connectedness between these 2 regions of the body.”
CRPS can also effect the head and neck and present as TMJ pain. (see abstract below)
Influence of the temporomandibular joint on range of motion of the hip joint in patients with complex regional pain syndrome.
This study evaluated if patients with complex regional pain syndrome (CRPS) would have an increase in range of motion (ROM) after myofascial release and a similar ROM decrease after jaw clenching, whereas in healthy subjects these effects would be minimal or nonexistent.
Documentation of patients with CRPS (n = 20) was established using the research diagnostic criteria for CRPS, questionnaires, average pain intensity for the past 4 weeks, and the temporomandibular index (TMI). Healthy subjects (n = 20, controls) also underwent the same testing. Hip ROM (alpha angle) was measured at 3 time points as follows: baseline (t1), after myofascial release of the temporomandibular joint (t2), and after jaw clenching for 90 seconds (t3). Comparison of the CRPS and control groups was made using t tests.
Mean TMI total score and mean pain reported for the last 4 weeks were significantly different between the 2 groups (P < .0005). Hip ROM at t1 was always slightly higher compared to t3, but t2 was always lower in value compared to t1 or t3 for both groups. The differences of all hip ROM values between the groups were significant (P < .0005). Moreover, the difference between t1 or t3 and t2 was significantly different within the CRPS group (t1 = 48.7 degrees ; t2 = 35.8 degrees ; P < .0005).
The results suggest that temporomandibular joint dysfunction plays an important role in the restriction of hip motion experienced by patients with CRPS, which indicated a connectedness between these 2 regions of the body.
Sympathetically maintained pain presenting first as temporomandibular disorder, then as parotid dysfunction.
Complex regional pain syndrome (CRPS) is a chronic condition that usually affects extremities, such as the arms or legs. It is characterized by intense pain, swelling, redness, hypersensitivity in a region not defined by a single peripheral nerve and additional sudomotor effects, such as excessive sweating. The clinical criteria for the diagnosis of sympathetically maintained pain as outlined by the International Association for the Study of Pain include: Onset following an initiating noxious event (CRPS-type I) or nerve injury (CRPS-type II). Spontaneous allodynia that is not limited to peripheral nerve distribution and is not proportionate to the inciting event; abnormal sudomotor activity, skin blood flow abnormality, edema, other autonomic symptoms; and exclusion of other conditions that may otherwise contribute to the extent of the symptoms. Only 13 cases of CRPSinvolving sympathetically maintained pain in the head and neck region have been described, and all reported trauma as the identifiable etiologic factor. The case presented here is another occurrence of sympathetically maintained pain in the head and neck region, but without nerve injury as a clear initiating factor.