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CRPS – What is it?

It is CRPS month in November. It is the month we colour the world orange to raise awareness of CRPS. But what is it and what to expect if you have received a diagnosis of CRPS?

Complex Regional Pain Syndrome (CRPS) is a challenging and perplexing condition for both patients and healthcare providers. It is characterized by severe, persistent pain and typically affects one limb after an injury, surgery, or stroke. The exact cause of CRPS remains unknown which contributes to the complexities of management. However, pain physiotherapists play a pivotal role in helping patients navigate the condition.

CRPS is typically divided into two types: CRPS-I (without a confirmed nerve injury) and CRPS-II (with a confirmed nerve injury). Symptoms of CRPS include throbbing pain, sensitivity, swelling, changes in skin temperature and colour and reduced movement. It is crucial to recognize these symptoms early because management is usually more effective in the early stages and limit progression of the condition.

Pain physiotherapists play an important role in the evaluation and treatment of chronic pain conditions like CRPS. We are trained to assess the multifactorial nature of pain and its impact on physical function. Through a holistic approach that encompasses the biopsychosocial model of pain, physiotherapists can tailor treatments to the individual needs of their patients.

Management strategies of CRPS include:

Education and Early Intervention: patient education is really important in CRPS management. Physiotherapists must ensure that patients understand their condition, the importance of maintaining movement in the affected limb, and how to manage pain at home. Early intervention is key to preventing secondary weakness from reduced movement.

Pain-Relief Techniques: Utilizing modalities such as transcutaneous electrical nerve stimulation (TENS), thermal therapies, and manual therapies can help alleviate pain. Graded Motor Imagery (GMI) and mirror therapy are also beneficial in retraining the brain the recognise the affected limb without eliciting pian.

Desensitization Therapy: Desensitization involves gradual exposure to various textures and stimuli to reduce hypersensitivity in the affected limb. This can be a crucial step in reintroducing normal movement and touch to the area.

Graded Motor Imagery: GMI is a sequential process that involves laterality training, motor imagery, and mirror therapy. It helps to retrain the brain and can reduce pain and improve mobility.

Exercise Therapy: Strengthening and aerobic exercises are essential to maintaining muscle strength and cardiovascular health. Gentle, controlled movements help to prevent or reverse the secondary musculoskeletal effects of CRPS.

Functional Restoration: Encouraging the use of the affected limb in daily activities is essential. This not only aids in maintaining joint mobility but also assists in functional integration, which can help to reduce pain perception.

Psychological Support: Given the chronic nature of CRPS, it is also crucial to address the psychological input. Pain physiotherapists can work in tandem with psychologists to address issues such as anxiety, depression, and coping strategies.

Managing Complex Regional Pain Syndrome requires a multifacted approach, combining patient education, pain relief techniques, desensitization therapy, graded motor imagery, exercise therapy, functional restoration and psychological support. Pain physiotherapists are at the forefront of CRPS management, helping patients to regain function and improve their quality of life. With ongoing research and a growing understanding of pain mechanisms, there is hope for better outcomes for individuals with CRPS. Those suffering from CRPS should seek a consultation with a qualified pain physiotherapist to explore their options for management and relief.

Example of therapy for CRPS – using flash cards as a desensitization technique. Therapy began with imaging performing the movement with affected hand, progressed to performing movement with unaffected hand, and finally progressed to this patient performing the movement with hand affected with CRPS.

Mirror box therapy for CRPS – This patient has CRPS in her right hand. The right hand is placed in the box and reflection of the left hand in the mirror creates and illusion of the right hand performing the movement. We’re trying to trick the brain to perform movements that would cause pain with affected hand. When this patient first attempted this, they experienced severe pain in her affected hand, just by looking at the reflection.

Keywords: Complex Regional Pain Syndrome, CRPS, pain physiotherapists, chronic pain management, graded motor imagery, desensitisation therapy, exercise therapy, mirror box, functional restoration, psychological support

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