Stages of Complex Regional Pain Syndrome
The concept of CRPS progressing through stages is controversial. Adults are much more likely than children to go through the three stages.
- • Stage 1 (acute stage): typically lasts 6 to 12 months, characterized by:
- Pain in the extremity or shoulder
- Swelling in the extremity
- Color change of the extremity (red or blue)
- Movement painful and tendency for immobilization
- Early osteoporosis on x-rays.
- • Stage 2 (dystrophic phase): persists an additional 1 to 2 years, characterized by:
- Pain usually continues
- Swelling changes to brawny hard edema
- Beginning of atrophy of subcutaneous tissue and intrinsic muscles
- Cooler extremity, which can be mottled or cyanotic
- Progression of osteoporosis.
- • Stage 3 (atrophic stage): persists up to several years, characterized by:
- Pain remains constant or diminishes
- Extremity becomes stiff
- Swelling changes to periarticular thickening
- Skin becomes smooth, glossy, and drawn
- Brittle nails
- May see muscle spasm, dystonia, and tremor
- Progression of osteoporosis with pathologic fractures
- Ankylosis in some patients.
Some have additionally postulated a fourth stage (psychological stage) characterized by loss of job, unnecessary surgery, orthostatic hypotension or hypertension, neurodermatitis, and depression. Although these stages can be useful, it is often difficult to place an individual patient into one of them. Most often, stages 1 and 2 are merged or fluctuate back and forth. A patient may stay in one stage for months or years, and another patient may progress rapidly through the stages. The earlier stages are much easier to treat than the later stages.