CRPS-- complex regional pain syndrome

CRPS

chronic pain and edema that is marked by hypersensitivity to touch, texture, and temperature; can occur spontaneously but typically starts with an injury and worsens/remains after the injury has healed

• high risk for CRPS after injury or stroke

• a neurological problem— not really physical!

“CRPS is FLUID and STRESS”

• “Calm, Reflection, Progressive Stimulation”

• “Fluidotherapy”

• “Stress loading”

symptoms

• pain

• swelling

• stiffness

• contractures

• discoloration (skin is blue or shiny red)

• hair growth

• temperature changes

• muscle spasms

• weakness

progression through 3 stages

1. traumatic stage

2. dystrophic stage (glossy + red appearance + heat)

3. atrophic stage (skin is dry and cool + decrease in experience of pain)

neuroplasticity

nervous system’s ability to adapt and change

• a nervous system dysfunction where the body’s pain response becomes a vicious cycle after the original cause for pain has healed

• your nervous system starts, misinterpreting all stimuli, painful, even things like mild temperature changes, textures, vibration, light, touch, etc.

  • luckily, this works in reverse

    • we help re-establish a positive, non-threatening perception of the area

comorbidities

• CRPS is typically accompanied by inflammation/edema

• we may notice and address early signs of CRPS while the original injury still needs to be considered

  • be sure that your treatment for one condition does not break a precaution of another

treatment

main goal: repair the broken relationship between the pain centers of the brain and affected body part

• to accomplish this, we’ll help the brain calm down, decrease perceived threat, and desensitize the area as much as possible

• can include

  • TENS

  • CPM (continuous passive motion)

  • splinting

  • address edema

  • de-sensitization

  • tendon glides

  • provide vasomotor challenge (e.g., stress-loading)

  • no splints; no casting

• “CRPS: Calm, Reflection, Progressive Stimulation”

calm

purpose: calm central nervous system activity level

• deep breathing

• mindfulness/relaxation techniques

• CBT (identify negative/unrealistic thought processes)

reflection— addressing threat level

purpose: lower perceived threat level

• mirror therapy: touching or moving the unaffected side while looking at its reflection; critical that the client attempts to perceive reflection as their actual body part

progressive stimulation— desensitization

textures, vibrations, etc.; start near (not directly on) the painful area and work into it

• SHOULD NOT BE PAINFUL (will only reinforce negative beliefs)

  • about building tolerance, not enduring pain

fluidotherapy

the primary modality to use with CRPS; it reduces pain and swelling

• tactile element (+ a little heat) is useful for desensitization

stress loading— stress loading

similar to isometric exercises and weight bearing

• pushing and pulling forces on the arm with minimal movement of the joints

• examples:

  • “scrubbing” tasks— e.g., washing a car, table, wall

    • with “stiff arm” for weight-bearing

  • “carrying” tasks— e.g., holding a weight or bag

contraindications

no PROM or painful interventions! “with COM(plex), no PROM”

• gentle AROM is okay