What is CPRS?
Complex Regional Pain Syndrome shortly named as CPRS is a chronic pain condition that mostly affects the limbs. In this post, we will talk about the common reason for CPRS spread.
Complex Regional Pain Syndrome (CPRS) diagnosed in the foot of a patient visited to the clinic. The CPRS was further spreading to his contra-lateral foot. I went to the literature to find out the reasons for why CRPS spreads.
After a quick search on Google Scholar, I was pleased to find an article published in the Journal of Neural Transmission (honestly the first time I ever heard of this journal) on the spreading of CRPS. In summary, this article has the following conclusions about the spontaneous spreading of CRPS which I found interesting…:
Out of 185 subjects studied over a 6 year period, 48% had multiple affected limbs. This is speculated to result out of the adaptation of the CNS in an attempt to adapt to the altered condition by remodeling or neuronal plasticity.
The syndrome started in 1 limb in 88% of patients. It started in 2 limbs in 11% of patients, and 4 limbs in 1% of patients.
Complex Regional Pain Syndrome spread in 78 patients. The severity of the CRPS did not vary greatly once spread.
Out of those who had to spread CRPS, 53% had to spread to the contralateral limbs and 32% in limbs. In 15% of cases, the spread was in a diagonal pattern (i.e. from L leg to R arm). So individuals with spontaneous spread to the contralateral limbs were 2.3x more likely for spread than ipsilateral and 25x more likely than diagonal spread.
The mechanism of ipsilateral spontaneous spread is unclear.
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Patients with multiple-CRPS were significantly younger than those with single- CRPS. This may be due to genetic factors/predisposition for this syndrome.
Contralateral spreading of Complex Regional Pain Syndrome is assumed to possibly arise via altered spinal processing of incoming sensory information within the medulla spinalis and brainstem. Thus spinal glial cells and pro-inflammatory cytokines may be important factors in this. Its spread probably involves different supraspinal mechanisms and noxious stimuli activate bilateral regions of the brain associated with descending pain pathways.
There is little data on the ipsilateral spreading of symptoms. However, the authors speculate that glial mediated changes at one segment of the spinal cord reach other segments by axonal transport via descending or ascending fibre tracts.