Chronic Regional Pain Syndrome: When Pain Does Not Make SenseMarch 25, 2015
So you recently suffered a minor sprain, scrape injury or underwent surgery. Your pain, however, is extremely intense and out of proportion to the injury. You may be suffering from Complex Regional Pain Syndrome (CRPS). Although this condition is not very common, when it does occur it can be very painful and disabling. It is important to pick up on the signs of CRPS early, as this can prevent it from developing into a chronic condition.
There are two types of Chronic Regional Pain Syndome; CRPS I and CRPS II. The difference between the two conditions is one is caused by injury to a tissue, such as skin or muscle (CRPS I), and the other is caused by injury to a nerve (CRPS II). However, the symptoms and treatments for both types are similar. CRPS is referred to as a regional pain syndrome because your symptoms are generally confined to 1 region of the body, such as a foot.
The exact cause of CRPS is unknown, but one possible explanation includes a heightened response to sensation by your nervous system after an injury or stress on the body. Typically after an injury, your nerves will get excited and send a message that it is injured. Your body responds to this message by sending healing agents toward the injured area by widening your blood vessels and increasing blood flow to the area. The result is redness and swelling. With CRPS, it is thought that this stage of healing does not stop, and the nerves continue to stay excited. Your brain and the injured area are sending mismatched messages to each other. As a result, the injured area can be overly sensitive, swollen, warm, and red. Undergoing a recent period of not moving the injured limb (cast or splint), smoking, and certain psychological factors can place an individual at increased risk for developing CRPS.
CRPS typically occurs in the foot or the hand that was injured. Your symptoms can spread further up the limb or over to the unaffected side. Individuals with CRPS experience extreme sensitivity to light touch. Everyday activities such as wearing a sock, bathing, or applying ice/heat can be very painful and difficult. The pain experienced is more extreme that what is expected from the original injury, and is usually described as constant burning, throbbing, or stabbing pain. Other symptoms include:
- Skin temperature that feels hotter or colder in the affected arm/leg.
- Sensitivity or pain to light touch
- Increased redness or discoloration of the affected arm/leg.
- Swelling around the limb
- Changes in hair and nail growth of the arm/leg
- Increased sweating observed at the arm/leg
- Weakness of the involved area
If left untreated, CRPS can develop into a chronic condition. Your symptoms can spread further up the involved arm/leg and breakdown of the muscles and bones will start to occur.
How can Physical Therapy Help Me?
Despite being able to determine the exact cause of CRPS, what we do know is physical therapy can be very helpful in managing your symptoms and regaining normal function. A multidisciplinary approach involving behavioral therapy and psychological support along with physical therapy may also be recommended. Although physical therapy can be quite painful initially, it is a very important part of regaining your function and preventing this condition from getting worse.
Treatment for CRPS will include:
Gentle Movement – Since your pain is exacerbated by moving the limb, you will have a tendency to guard the limb and not move at all. This can actually make things worse causing your muscles and joints to tighten and breakdown. Eventually, the joint will become stuck in that position if not treated. Your therapist will begin gently moving the arm or leg as soon as possible in order to maintain motion of your joints. Your therapist will also encourage weight bearing of the limb in order to prevent further bone loss.
Desensitization – Your therapist will apply different textures and sensations to the affected area in order to help reduce the sensitivity and painful symptoms. Initially softer textures are used, such as a soft towel or cotton ball. As you become less sensitive, your therapist will gradually increase the stimulation by rubbing or tapping with different textures and pressure.
Graded Motor Imagery – This is a process that exercises the brain, encouraging the “correct” messages are sent to and from the injured limb. Graded Motor Imagery involves multiple steps that are carefully progressed by your therapist. In the first step, your therapist may show your flashcards of different limbs and ask you to distinguish between right and left. The next step involves imagined movement, and your therapist will ask you to imagine moving your hand or foot without actually moving the limb. The final step involves mirror therapy.
Mirror Therapy – Also used in Graded Motor Imagery, your therapist will use a mirror in addition to your exercises. This type of therapy involves you exercising your unaffected arm/leg in front of a mirror while watching the reflection. The reflection looks as if the injured arm/leg is performing pain free exercise.
As your pain decreases and your symptoms become more manageable, your therapist will gradually add strengthening and stretching exercises, as well as hands on therapy to help increase movement and strength in the affected limb, allowing you to return to your everyday activities.
The symptoms of CRPS can vary from person to person, but your physical therapist will provide an individualized treatment that will help address your symptoms. Unfortunately, there is no way to prevent CRPS since the mechanism of how CRPS occurs is unknown. However, long-term outcomes are improved if treatment is started early. For more information on physical therapy services visit www.totalperformancept.com.