Pain management

CRPS is a chronic pain condition most often affecting women and generally impacting the arms and legs. It typically occurs between 40 and 60 years of age but can occur at any age.

Types of CRPS

There are two types of CRPS. Although the symptoms are similar for each, they have different causes:

• Type 1 (also known as reflex sympathetic dystrophy) — Occurs after an illness or injury that did not cause nerve damage in the affected limb. A majority of people (approximately 90 percent) with CRPS have Type 1.
• Type 2 — Follows a distinct nerve injury. Specifically, various types of trauma — such as a gunshot wound, shrapnel blast, surgery, heart attack, infection or fracture.

Treating CRPS

Treatments for CRPS can include:

• Applying heat and ice
• Biofeedback
• Capsaicin cream
• Physical therapy
• Spinal cord stimulation
• Sympathetic nerve-blocking medication
• Transcutaneous electrical nerve stimulation

Neuromodulation is a term doctors and specialists use to describe a way to stimulate your nerves. It is most often used to help control pain and certain neurological conditions — such as movement disorders — through stimulation of the spinal cord or peripheral nerves. It can also be used to treat obstructive sleep apnea, when other treatment methods are ineffective.

Among other things, we use this advanced treatment to help patients who have:

• Abdominal pain
• Foot pain
• Movement disorders, including epilepsy (seizure disorder) and Parkinson's disease, including epilepsy (seizure disorder) and Parkinson's disease
• Neck, back or spine pain
• Pelvic pain
• Severe headaches
• Spasticity

Pelvic pain occurs mostly in the lower abdomen area, below the belly button. The pain might be steady, or it might come and go. If the pain is severe, it might impact your daily activities. Painful pelvic conditions include:

• Bladder, bowel and sexual function disorders
• Endometriosis
• Neuromyofascial pain (pain related to nerves and muscles)
• Other inflammatory conditions

TOS causes pain, numbness, tingling and/or weakness in the arm and hand. This happens because of pressure against the nerves or blood vessels that supply blood to the arm. These issues impact the thoracic outlet, which lies just behind the collar bone.

Causes of TOS

TOS is often produced by hyperextension neck injuries, such as whiplash from car accidents or repetitive stress in the workplace. In some people, symptoms develop spontaneously without an obvious cause. Some of the occupations that we see causing TOS include:

• Filing or stocking shelves overhead repeatedly
• Long stretches spent typing on keyboards or 10-keypads
• Working on assembly lines

On rare occasions (affecting one percent of the population), an extra rib in the neck is present. People born with this rib — called a "cervical rib" — are ten times more likely to develop symptoms of thoracic outlet syndrome than those without the extra rib. However, even in both men and women with cervical ribs, it usually requires some type of neck injury to spark symptoms.

Treatments for TOS

Most people with thoracic outlet syndrome will improve with stretching and physical therapy. In our experience treating over 5,000 people with TOS, less than 30 percent had surgery.

However, when surgery is required to treat a patient’s TOS, we provide it at the Center for Thoracic Outlet Syndrome at Presbyterian/St. Luke's Medical Center. This surgery helps by taking pressure off the nerves to the arm through the removal of the muscles that surround the nerves (scalene muscles), removal of the first rib or by doing both (removing muscles and first rib).