Many patients who I see with complex regional pain syndrome (CRPS) display great sensitivity. The affected area is being vehemently protected in a number of ways, for example with a splint, a boot or consciously by avoiding situations. Protection also comes in the form of vigilance to potential dangers and anticipation of an activity that may hurt.
When the sensitivity reaches a significant level, the protection can be such that simply observing another person move their equivalent body part is enough to evoke an unpleasant response. Frequently this is an aversive reaction, turning away and wincing as if the sight is gruesome or disgusting. The visceral feeling that viewing someone else move can evoke can be accompanied by pain. These are the dimensions of pain at play, with different brain pathways underpinning the experience that is played out via the physical ‘self’, the body.
When this response is identified, we know that it must be desensitised. We should be able to watch someone move and be comfortable doing so. Equally, under normal circumstances we can mentally rotate our body, for example imagine and feel the sense of moving a foot up and down or opening and closing a hand. In CRPS and other conditions that are underpinned by changes in the central nervous system, including the sensory and motor areas, it becomes difficult to perform such an action.
We can follow a training programme to desensitise via graded exposure alongside strategies that develop resilience. This is a physical-cognitive-emotional approach that considers the individual as much as the condition, habituating and turning down the gain on a system that has ramped up its protection. Progressing on to motor rehabilitation to develop precision of movement usually requires a baseline that begins with the planning stages of movement where the brain can instigate guarding.
Increasing understanding of pain, movement, the brain, protection, cognition, anxiety, stress physiology and other related areas allows for far more integrated treatment and rehabilitation techniques that tap into the plasticity of the neuroimmune system. In short this means we can change. Creating the right environment and opportunity for change is equally important.
Let’s do it. Let’s look.
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