Complex Regional Pain Syndrome (CRPS), also known as Reflex Sympathetic Dystrophy (RSD) is a condition that can be extremely limiting and distressing, pervading all aspects of daily living. More and more is being understood about CRPS meaning that treatment and management strategies are moving forwards. In particular, the techniques that target the brain changes that occur in CRPS and other pain states such as the graded motor imagery programme. There have been numerous studies showing us that these changes take place in both the motor and sensory cortices, underpinnig some of the main experiences in CRPS such as pain, altered perception and movement control.
Budapest Diagnostic Criteria – click here
Click these links for some of this work
Impaired hand size, clinical features of CRPS, new concepts, endogenous pain modulation, motor system changes, TNF-alpha in CRPS, cortical reorganisation, cortical changes in CRPS, functional imaging in CRPS.
CRPS is typically termed Type 1 and Type 2:
Type 1: No nerve injury
Type 2: Associated with a major nerve injury
In a sense this can be quite useful, however in Type 1 it is quite feasible that the injury includes damage to nerve tissue and consequently it is really Type 2. This is the same with other painful conditions including back pain when there can be several pain mechanisms and types at play. When a nerve is injured or damaged, we can experience neuropathic pain, a common featrure of CRPS. However, this can co-exist with other pains such as inflammatory pain, consequently an approach that identifies pain mechanisms is key.
The symptoms of CRPS can include pain that is often well out of proportion to the injury, swelling, changes in perception of the affected area, altered sensation (pins and needles, numbness), changes in temperature (often warmer initially, becoming cooler with time), altered colouring to a mottled effect that can be very changeable, sweating changes (increased), reduced mobility and control of movement, dystonia in some cases, skin and nail changes.
This range of symptoms is underpinned by changes in nervous system activity, immune activity, endocrine system activity and blood flow changes. These systems work in an intergrated fashion to ‘protect’ us from potential threat and consequently a number of well orchestrated processes are functioning to deal with the problem. Pain is part of the protection, as is changing in the way we move. This is useful following an injury as it allows for healing to take place, however as time goes on the pain is less an indicator of tissue damage and more about on-going protection. There are reasons of course and that includes the fact that often the tissues are not as healthy as they once were due to changes in use, persisting inflammation, altered blood flow and other local changes that develop. There are also the psychological ‘threats’ including thoughts about the condition, how it affects our ability to work and take part in normal daily living and other negative thoughts that trigger stress responses.
Understanding that pain is a brain experience is important. The brain protects us with this ‘device’ that is influenced by many factors including emotional state, past experiences of pain, stress, fatigue, beliefs, gender and general health. Clearly the physical management of CRPS is vital including exercise to promote tissue health, mobility and control of movement, techniques that target the higher level changes such as the GMI programme, desensitising techniques both in the clinic and at home, self-care strategies and the development of understanding and coping skills to optimise the training effects. For further details of treatment click here
The modern view upon CRPS and its management must incorporate current thinking in neuroscience and consider pain as a biopsychosocial experience. Drawing upon evolving knowledge allows treatment programmes to become increasingly effective for CRPS and other on-going pain states.