Complex regional pain syndrome (CRPS) causes intense, chronic pain for those who are afflicted. While there is no single cure, a number of treatments exist to alleviate symptoms. In certain cases, CRPS surgery is performed. There are a number of CRPS surgery procedures. The type of CRPS surgery performed is based on a number of CRPS symptoms and patient circumstances. These circumstances include the cause of CRP pain, location, and effectiveness of previous types of treatment.
CRPS Surgery Considerations
Before considering CRPS surgery, patients and their doctors should discuss specific symptoms and whether or not the patient is a solid candidate for each suggested procedure. In many cases, CRPS surgery presents risks to the patient. Some patients have found that further alteration of the affected limb through CRPS surgery can have a reverse affect. In these cases, CRPS surgery may exacerbate the patient’s pain and cause additional damage to the nerves.
Nerve Decompression CRPS Surgery
In certain cases, medical professionals may trace the cause of CRPS to a compressed nerve in the patient’s limb. When a nerve is compressed, tissue surrounding the nerve often places abnormal pressure on the nerve. This can obstruct blood flow and cause swelling and pain in the affected area. During nerve decompression surgery, the nerve is released from excess pressure and returned to its normal state.
Sympathectomy CRPS Surgery
Sympathectomy is performed to interrupt the portion of the patient’s sympathetic nervous system that is affected by CRPS. During sympathectomy, the sympathetic ganglia that cause CRPS pain are cut or destroyed. Sympathetic ganglia are collections of nerve cells that occur in clusters along the mid or lower spinal cord. Sympathectomy can take the form of CRPS surgery, chemical treatment, or radiofrequency treatment.
It is recommended for patients who receive significant pain relief from a type of CRPS therapy called sympathetic nerve blocks. Sympathetic nerve blocks involve injecting anesthetics into sympathetic nerves that are affected by the condition. This may be performed using different methods, such as laparoscopy and surgery under general anesthesia. Sympathectomy may also be used to treat hyperhidrosis, a condition characterized by excessive sweating.
Sympathectomy is controversial, as there is little evidence to fully support the efficacy of the procedure. Many deem this procedure risky due to the irreversible damage to sympathetic nerves. It is typically a “last resort” procedure for patients who face edema, tissue loss, and recurrent infection. A number of researchers and medical professionals do not support sympathectomy as CRPS surgery.
Neurostimulation CRPS Surgery
Neurostimulation is a type of CRPS surgery that directly stimulates specific nerves. Neurostimulation is administered by electrodes that are surgically implanted within the patient’s pain pathway. The electrodes deliver small electrical currents to the nerves, which results in pain relief for the patient. Once implanted, the electrodes are programmed based on each patient’s specific CRPS pain symptoms. The stimulator can be turned on and off, and adjusted using an external controller.
Neurostimulation often involves the patient’s spinal cord. During spinal cord stimulation, a needle is used to place the electrodes near the spinal cord. Minor surgery is also performed to implant additional parts under the patient’s torso skin. Neurostimulation may also be delivered to other locations in the patient’s body, such as peripheral nerves or in the outer membranes of the brain.
Pain Pump Implantation
Intrathecal drug pumps, also known simply as “pain pumps,” deliver pain-relieving medications into the fluid that surrounds the spinal cord. These medications are typically opioids or local anesthetics such as baclofen or clonidine. The major benefit of pain pump implantation over oral pain relievers is that significantly less medication is required to achieve the same level of pain relief. This is because pain pumps deliver medication directly to the pain pathway.
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