Complex Regional Pain Syndrome

Complex regional pain syndrome is a type of condition that is an uncommon form of chronic pain affecting a leg or an arm. The syndrome normally develops after an injury, stroke, heart attack or surgery, but the pain tends to be out of proportion in relation to the severity of the initial injury. The cause of the syndrome isn’t understood clearly. Treating complex regional pain syndrome tends to be the most effective when it begins at an early stage. Remission and improvement are both entirely possible.

CRPS most commonly occurs following surgery. The patient is expected to recover as normal, and the surgeon reports that the surgery went well, but for some reason (unbeknown to the medical profession) the patient experiences severe pain in the affected area, or around the area.

Some theorists believe that CPRS is caused by an over-reaction of the central or peripheral nervous system, or hyper-sensitisation of the nerves.

Some people still call CPRS by its less used name, reflex sympathetic dystrophy. CPRS can be extremely painful, with some people rating it above child birth. It can also be very difficult to control the pain and different medication and pain relief should be tested to determine what will work best. 

Complex Regional Pain Syndrome Anatomy

CRPS is a chronic condition affecting one of the limbs after an injury to that limb. It is attributed to malfunction or damage to the central nervous system, which is composed of the spinal cord and the brain. It is responsible for the nerves signaling the spinal cord and the brain to the body. 

How to Treat Complex Regional Pain Syndrome:

  1. Applying Cold and Heat

Applying cold and heat can help reduce inflammation and sensitivity. Use cold first, and then the heat, and repeat as required (or as advised by your therapist). The length of time you use the cold and heat can also vary for individuals.

  1. Acupuncture

Acupuncture (both Western and Eastern forms) can be used to reduce sensitivity of the area. Acupuncture helps reduce the nerve impulses travelling to the affected area, in a theory known as the pain gate theory. Patients have shown remarkable recoveries and benefits following acupuncture, especially when used specifically over the area of pain.

  1. Topical Analgesics

Various creams can be used to reduce hypersensitivity, such as that of clonidine, ketamine, amitriptyline or lidocaine.

  1. Physical Therapy

Guided and gentle exercising of the limbs that are affected will help to decrease pain and improve the range of movement and strength. The earlier the condition is diagnosed, the more effective the exercises are going to be in the long run.

  1. Biofeedback

In certain instances, learning the techniques of biofeedback will help in the healing process as well. When it comes to biofeedback, you need to become a lot more aware of your body so that you are able to relax your body and help to alleviate pain.

  1. TENS

Chronic pain can be relieved by using an electrical impulse on the nerve endings. TENS needs to be used regularly for a few weeks to notice benefits, so be persistent.

  1. Spinal Cord Stimulation

The doctor will insert tiny electrodes all along the spinal cord. A small current will be sent to the spinal cord to provide you with pain relief. You will need to discuss with your consultant if this may be an option for you, but generally speaking its rarely performed.

  1. Antidepressants

Antidepressants, such as amitriptyline, and an anticonvulsant, like Neurontin, are used for treating pain originating from damaged nerves. In recent times, the use of anti-epileptics has also started to become commonplace. Anti-epileptics can reduce the nerve impulses in the brain and spinal cord. Common anti-epileptics include gabapentin and pregabolin.

  1. Bone-Loss Medications

Certain medications can help to stall or prevent bone loss, such as Miacalcin and Fosamax.

  1. Corticosteroids

Steroid medications can help to reduce inflammation and increase range of mobility within the affected limb. Also steroid medication such as prednisilone can be used to reduce inflammation around the body, but should only be used short term (many practitioners only use this treatment for up to 1 week).

  1. Anti-Inflammatory Medication

OTC pain relievers, like ibuprofen, aspirin and naproxen, will help to ease inflammation and pain. Doctors can prescribe a stronger form of pain relief if an over-the-counter one is not helpful. When taken in appropriate doses, opioid medications can be quite effective in controlling pain. Certain pain medications increase the potential for stroke and heart attack, so you want to discuss those medications beforehand.

Tips:

  1. CPRS is complicated, and usually requires specialist care.
  2. You may need to test different types of medication and pain relief as some people respond to some, and some respond to others. As CPRS can be so painful, it’s important to get the right medication to allow you to cope/manage the pain. Some pain medications include anti-inflammatories, and also muscle-relaxants, and morphine based medication. Following from this, some doctors may prescribe low-dose anti-depressants (for pain relief) and anti-epileptic medication to numb the nervous system.
  3. Doctors may also chose to use local anesthetic or steroid injections to control the pain.
  4. CPRS can sometimes occur after surgery, and there has been some research to suggest that daily vitamin C (500mg) can reduce the likelihood of onset.
  5. Where possible, eat organic foods and avoid processed foods. Processed foods tend to be pro-inflammatory increasing pain levels.
  6. Supplementation with fish oils can be helpful.
  7. If you have suffered with a stroke, early mobilization will help to lower the risk of getting complex regional pain syndrome.
  8. Sprained ankles, heart attacks, infections and surgery are all contributors to the syndrome.
  9. Forceful trauma to the leg or arm can cause this condition.

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