the different stages of CRPS.
CRPS is usually described in three different
Stage 1: acute or hyperemic stage. This stage occurs within days to weeks of the initial injury and is signifi-cant for
a predominance of severe burning or lancinating pain. It is notable for signs
of sympathetic blockade; thus the area affected is red, warm, and dry.
Hyperesthesia, an exaggerated response to stimuli, and allodynia, a painful
response to non-painful stimuli, are prominent symp-toms of this stage.
Treatments instituted during stage 1 have the best prognosis for a cure.
Stage 2: dystrophic stage. This stage occurs weeks to months after the initial insult. The signs and symptoms of this
stage are consistent with sympathetic hyperex-citability. The area involved is
pale or cyanotic and cool. Burning pain associated with hyperesthesia and
allody-nia is again very common. Although treatments in this stage can be
successful, the longer the duration of the symptoms the poorer the prognosis.
Stage 3: atrophic stage. This stage occurs months to years after the initial injury. Atrophy of
the tissues in the involved area occurs because of prolonged vasoconstric-tion
caused by increased sympathetic discharge over time. Burning and hyperesthesia
become less prominent and trophic changes predominate. The skin in the area
becomes smooth and glassy and the hair begins to fall out. The nails become
brittle and the muscles atrophic. The bones in the area show a classic patchy
demineral-ization on radiography known as Sudeck’s atrophy of the bone. The
prognosis for pain relief and functionality is very poor at this point.
It is common for a patient not to experience
all three stages of the syndrome. Stages may be skipped or the pro-gression may
be halted with appropriate therapy.