Algoneurodystrophy or algodystrophy is the old name for Complex Regional Pain Syndrome (CRPS). Its treatment relies on physical therapy and medication to relieve pain and preserve joint mobility.
What is Algoneurodystrophy?
Algoneurodystrophy (usually called algodystrophy and today called Complex Regional Pain Syndrome) is a regional pain syndrome localized around one or more joints, which associates continuous pain with exaggerated sensitivity to a painful stimulus or a painful sensation to a non-painful stimulus), progressive stiffness, vasomotor disorders (hypersudation, edema, skin coloration disorders)
The lower limbs (especially the foot and ankle) are more affected than the upper limbs. Algodystrophy is a benign disease. It regresses in most cases in a few weeks to a few months but the evolution can be prolonged over 12 to 24 months. Most often, it heals without sequelae.
The mechanisms of algodystrophy are not known. It could be a dysfunction of the central and peripheral nervous system.
There is most often a triggering factor: traumatic causes (sprain, tendonitis, fracture…) or non-traumatic causes (osteoarticular causes such as carpal tunnel syndrome or inflammatory rheumatism; neurological causes such as a stroke; cancer causes; neurological causes such as phlebitis; infectious causes such as shingles…) Surgery, especially orthopedic surgery, is also a frequent cause of algoneurodystrophy.
Trauma is the most common cause of algoneurodystrophy or complex regional pain syndrome. There is a delay of a few days to a few weeks between the trauma and the algodystrophy.
In 5 to 10% of cases there is no triggering factor.
The diagnosis of algoneurodystrophy or complex regional pain syndrome is based on the questioning and clinical signs. International diagnostic criteria are used. Additional examinations may be performed: X-ray, MRI, bone scan, etc.
The people concerned
Complex regional pain syndrome is rare. It most often occurs between the ages of 50 and 70, but is possible at any age and is exceptional in children and adolescents. CRPS affects more women than men (3 to 4 women for 1 man).
Symptoms of algoneurodystrophy
Pain, the main symptom
Algoneurodystrophy is characterized by continuous pain, with hyperalgesia (exaggerated sensitivity to a painful stimulus) or allodynia (painful sensation to a non-painful stimulus); progressive stiffening; and vasomotor disorders (hypersudation, edema, and skin discoloration).
Three phases are described: a so-called hot phase, a so-called cold phase and then healing.
A hot inflammatory phase…
The first phase, known as the hot phase, evolves progressively over a period of several weeks to several months after the triggering factor. This hot inflammatory phase is characterized by joint and periarticular pain, edema (swelling), stiffness, local heat and hypersudation.
…then a cold phase
This is characterized by a cold limb, smooth and pale, ashen or purplish, very dry skin, capsulo-ligamentary retractions and joint stiffening.
Algoneurodystrophy or Complex Pain Syndrome can actually present with a cold phase from the start or an alternation of cold and warm phases.
Treatments for Algoneurodystrophy
The aim of treatment is to relieve pain and preserve joint mobility. It combines rest, physical therapy and analgesic drugs.
During the warm phase, the treatment combines rest, physical therapy (physiotherapy for pain relief, balneotherapy, circulatory drainage).
During the cold phase, physical therapy aims to limit capsuloligamentary retractions and to fight against joint stiffening.
If the upper limb is affected, occupational therapy is necessary.
Several drug treatments can be combined: class I and II analgesics, anti-inflammatories, regional blocks with anesthetics, transcutaneous electrical neurostimulation (TENS).
Intravenous biphosphates may be administered in cases of severe algodystrophy.
Orthoses and canes can be used for pain relief.
Prevention of algoneurodystrophy
It would be possible to prevent algoneurodysyrophy or complex regional pain syndrome after orthopedic or traumatic surgery by better managing pain, limiting cast immobilization and implementing progressive rehabilitation.
A recent study showed that taking 500 mg of vitamin C daily for 50 days reduced the rate of complex regional pain syndrome one year after a wrist fracture. (1)