What to do when your brain is in pain?

Complex Regional Pain Syndrome (CRPS) can be a painful and disabling condition. CRPS generally arises from a minor injury, such as a scrape, sprain, or strain and can result in the syndrome that is defined as being complex, regional (symptoms are generally in 1 region of the body), and painful.

A multi-disciplinary approach to treatment is currently recommended, consisting of care from physicians, psychologists, and physiotherapists.

What is Complex Regional Pain Syndrome (CRPS)?

CRPS, formally known as RSD (regional sympathetic dystrophy), is considered to be a multi-system disorder characterized by severe pain; pathological changes of the bones, joints, and skin; excessive sweating; tissue swelling; and hypersensitivity to light touch. It is generally categorized as one of 2 types:

• Type 1: not resulting from a distinct nerve injury
• Type 2: resulting from a distinct nerve injury

CRPS involves the central nervous system, autonomic nervous system, and immune system. Although research has not yet determined exactly why CRPS occurs, physiotherapy has proved to be quite beneficial in managing its symptoms, improving function, and increasing the quality of life for people with CRPS.

How Does it Feel?

Most people with CRPS experience:

• Extreme sensitivity to light touch—a symptom known as tactile hyperesthesia. Common everyday activities, such as wearing clothing, bathing, or applying skin creams or lotions may become very difficult and uncomfortable.
• Significant pain, often described as burning, stabbing, grinding, or throbbing that is often more extreme than what would be expected from the original injury.

Specific signs and symptoms may include:

• Pain and sensitivity to touch.
• A higher or lower skin temperature in the affected limb.
• Discoloration of the affected limb.
• Awkward positioning of the affected limb as a result of sustained muscle contractions. (This condition, known as dystonia, occurs in about 25% of CRPS cases.)
• A change in the appearance of hair and nails on the affected body part.
• Tissue and joint swelling.
• Heightened release of sweat by the affected limb.

Other symptoms reported by people with CRPS include increased difficulty in sleeping, decreased sexual desire, increased irritability or agitation, depression, and memory loss.

How Is It Diagnosed?

A diagnosis of CRPS is generally made by a physician who is familiar with the syndrome, such as a neurologist. Your physician may first attempt to rule out other conditions, such as Lyme disease or peripheral neuropathy, before making a definitive diagnosis.

A physiotherapist may be the first practitioner to recognize the onset of CRPS. If your physiotherapist suspects the condition may be present, the therapist will discuss those concerns with you and your physician to determine the best plan of action for your care. If suspected, your physiotherapist may ask if you have experienced any of the signs or symptoms noted above.

How Can a Physiotherapist Help?

physiotherapists play a vital role in the treatment of CRPS. Your physiotherapist will work with you to develop a treatment plan to help address your individual condition. Because the symptoms of CRPS vary, the approach to care will also vary. CRPS treatment is generally based on the chronicity and severity of the episode.

Treatment for CRPS may include:

Movement therapy. Mobilisation of the affected body part, begun immediately following diagnosis of CRPS, is crucial to help prevent contractures (the tightening of muscles or joints), and to maintain function. Therapy may include a combination of passive and active movements; the best treatment for your specific condition will be determined by your physiotherapist.

Graded Motor Imagery (GMI).All movements, even the smallest ones, are a result of complex computations of various networks within the brain. GMI is a rehabilitation process often used to treat disorders, such as CRPS, that result in pain and movement problems. GMI exercises the brain in measured and monitored steps and includes left and right discrimination training, motor imagery exercises, and mirror box therapy.

Mirror Box Therapy. Usually introduced as the third step in a typical GMI protocol, mirror box therapy requires an individual to exercise their unaffected limb in front of a mirror, while watching the reflection, as if their affected limb were performing the exercise.