Treatment and Therapies
There is no cure for Complex Regional Pain Syndrome (CRPS), diabetes, or the common cold. However, with the correct treatment, CRPS is manageable.
The goal of treatment is to decrease your pain and other symptoms, restore function, and maintain quality of life. It is important to start treatment as early as possible during CRPS, as the movement of the affected limb is crucial. Treatments and therapies may have different outcomes for different people.
Treatment methods include:
Physiotherapy, Occupational Therapy, and Exercise Physiologist.
Physiotherapy helps to restore movement and function when someone is affected by injury, illness or disability. It takes a holistic approach that involves the patient directly in their care.
Physiotherapists generally assist you by supplying the following:
- Education & advice
- Movement-tailored exercise and physical activity advice
- Manual therapy
Occupational therapy can help when someone struggles with everyday tasks (the tasks that 'occupy' them). An occupational therapist (an 'OT') can identify your strengths and difficulties, such as dressing or getting to the shops. They can then help you work out practical solutions.
OTs work with people of any age, including children and older people, to help them do things that 'occupy' their time. These can include:
- looking after yourself (self-care)
- work or school
- social activities
- hobbies
- being part of your community
OTs do many things. They might also:
- help with rehabilitation after an accident or illness
- work with children such as those with learning difficulties
- develop strategies to help with a disability or mental health issues
- help improve your confidence in social situations
An OT can help you maintain, regain or improve your independence. Your OT may suggest different techniques, such as changing your environment or using new equipment to help you achieve your goals.
Exercise Physiologists (EPs) are qualified allied health professionals with the knowledge, skills and competencies to design, deliver and evaluate safe and effective exercise interventions for people with acute, sub-acute or chronic medical conditions, injuries or disabilities.
Your Physio and OT may work with an Exercise Physiologist to assist you with the best exercise interventions for your rehabilitation requirements.
Mirror Therapy uses a mirror to trick your brain into perceiving movement in the affected limb without pain. Looking at the reflection of the movement of your unaffected limb in a mirror fools your brain into thinking you are moving two normal limbs.
Desensitisation involves touching the affected area with materials of different textures and weights and even placing the affected limb into the water at warmer and cooler temperatures by exposing the affected area/limb to various things. Desensitisation is essential for most other treatments, therapies, hygiene, and general life requirements.
Psychologist Patients with CRPS have high rates of psychiatric comorbidity. A survey hosted on the Reflex Sympathetic Dystrophy Syndrome Association (RSDSA) website found that 77.2% of patients reported feelings of depression, and 78.2% reported periods of anxiety. Alarmingly, half of the patients (438/888) reported having considered suicide at some point during their illness, with 66 (15.1%) of these patients attempting suicide.
Due to complex and high pain levels, plus severe psychological and emotional issues, CRPS treatment is more effective at a holistic level. This condition's physical, psychological and emotional impact must be accurately and sensitively researched, diagnosed and treated. A multi-disciplinary team, with each professional working effectively in their area of expertise, to treat the condition and give patients back their lives! (https://www.londonpainclinic.com/complex-regional-pain-syndrome/why-complex-regional-pain-syndrome-requires-a-multidisciplinary-approach/)
Medications for Reducing Pain.
The choice of medication(s) during the acute stage of CRPS varies from patient to patient.
Your General Practitioner (GP) and Pain Specialist (PS) will consider such factors as your age, other existing health conditions, any current medications you are taking, and the potential for side effects or interactions with your current medications.
With no specific CRPS treatment medication, your GP and PS may suggest topical analgesic creams and patches to manage pain.
Your Specialist may also suggest:
- Ketamine Infusion
- IV infusion allows the drug immediate access to the bloodstream. The infusion generally takes several hours, and a series of ketamine treatments are usually recommended.
- Sympathetic Nerve Block
- Sympathetic nerve blocks are a first-line treatment option for CRPS. However, they do not work in all cases, and their pain-relieving effects may decline over time. For individuals who do experience pain relief, the relief can last for weeks or months. Sympathetic nerve blocks are generally given 1‒2 times per week. Approximately 4‒5 blocks are required to achieve maximum results. https://www.painscale.com/article/sympathetic-nerve-blocks-for-complex-regional-pain-syndrome-crps
- Spinal Cord Stimulator
- Spinal Cord Stimulator delivers low levels of electrical pulses into the epidural space. These impulses block the pain signals before reaching the brain, replacing the pain with a more pleasant or no sensation. It is an excellent option if other conservative therapies, such as physical therapy, medications, and nerve blocks, don't help. https://www.apmconline.org/blog/treating-complex-regional-pain-syndrome-with-spinal-cord-stimulation
- Dorsal Root Ganglia Stimulation
- The difference between DRG Therapy and Spinal Cord Stimulation Therapy is the precision that DRG Therapy offers. Spinal Cord Stimulation provides a broad spectrum coverage for radicular pain, while DRG Therapy can provide a more precise delivery of analgesia. DRG Therapy delivers pain relief to the lower back, the groin, and even one single toe. https://southernpainclinic.com/blog/drg-therapy-for-crps/
- Scrambler Therapy
- Scrambler Therapy's success in neuropathic and oncologic pain is statistically very high but strictly dependent on correct usage and compliance with standard protocols described in this site and primary training courses. Apart from diseases that call for more experience (phantom limb, painful anesthesia, pudendal neuralgia, trigeminal and some specifically severe forms of CRPS or CIPN), the minimum success (Pain Relief >50%) should overtake by far 80%. https://www.scramblertherapy.org/patientinfo.htm
Alternative therapies for reducing pain: Among these methods are cognitive behavioural therapy, biofeedback and other relaxation techniques, acupuncture, hypnosis, reiki, kinesiology and chiropractic.
Each person’s experience with CRPS is different.
Multi-disciplinary treatment of CRPS is essential for optimal outcomes.
Therefore, you, your medical specialists, and your allied health providers must collaborate.
The members of your multi-disciplinary team may not look the same as in this example and may change positions often as your needs transform.
You will only need a Podiatrist for foot injuries. You may want to replace them, or another of these suggestions, with an acupuncture practitioner, rheumatologist, or other medical or allied health professionals.
Multi-disciplinary treatment of CRPS is essential for optimal outcomes.
Therefore, healthcare providers must work with each other, and the patient, as a team.
Whether you are an anesthesiologist, neurologist, pain specialist, or primary care physician, you should also include a physical therapist, occupational therapist, pain psychologist, and possibly a vocational specialist on your management team.
Patients with CRPS have high rates of psychiatric comorbidity. A survey hosted on the Reflex Sympathetic Dystrophy Syndrome Association (RSDSA) website found that 77.2% of patients reported feelings of depression and 78.2% reported periods of anxiety.² Alarmingly, half of the patients (438/888) reported having considered suicide at some point during their illness, with 66 (15.1%) of these patients attempting suicide.²
With complex and very high pain levels as well as severe psychological and emotional issues, the only way that CRPS can be effectively treated is by looking at the patient as a whole. The physical, psychological and emotional impact of this condition all needs to be accurately and sensitively researched, diagnosed and treated. This is why the only appropriate approach to treating complex regional pain syndrome is through using a multi-disciplinary team, with each professional working effectively in their area of expertise, to treat the condition and give patients back their lives!
If you need assistance finding a health professional in your area, you may find Painaustralia's Pain Directory helpful.
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DESENSITISATION
Allodynia is a painful sensation caused by innocuous stimuli caused by touch, a light breeze and numerous other things that shouldn’t, and generally wouldn’t, cause pain. Allodynia is associated with nerve damage in conditions such as CRPS, Fibromyalgia, etc. It is likely to become an increasing clinical problem, which can also interfere with treating your primary condition(s) – physiotherapy, scrambler therapy, chiropractic treatment, etc.
You can start desensitising your Allodynia yourself in several ways, which may allow you to do it in your own time, at your own pace, in the manner of your choice, and without feeling pressured or rushed.
The suggestions listed are in no particular order and are simply suggestions. Some may work for you; some may not. I have listed them as I found them.
- Put your foot or hand in a suitably sized box with a good layer of raw rice in the bottom. Scrunch your toes or fingers in the rice as you might in the sand. Move your foot or hand around and gently sprinkle rice over your foot or hand. Alternate feet and or hands if required
- Get three types of material or clothing made from different materials: soft, medium, and rough. Carefully and gently run each piece over the affected area. (Only use the material(s) your skin can cope with). It may take some time to work into.
- Place some dice on the floor for feet and the table for hands. Pick up and move each dice using your affected foot or hand only if both feet and hands are affected; swap and repeat.
- Try the above with dominoes. Instead of picking them up, move them to link together at connecting ends.
- Water Therapy – In a suitably sized bucket or tub, with water at a temperature best suited to your preference, place ¼ to ½ cup Epsom salts. Move your affected foot or hand in the water while your skin absorbs the always-helpful magnesium.
If you are preparing for Scrambler Therapy, it is suggested that you apply and remove, sticky plaster or Band-Aids from the affected area, to get used to not only the placement and removal but also the picking to get a grip on the edge of the applied object.
Water Therapy – Hydrotherapy
Using Somatosensory Rehabilitation to Treat Allodynia: “Somatosensory rehabilitation for pain” [#NeuroPainRehab] is a treatment method that includes strategies to help therapists and other health care providers assess and treat Allodynia.
https://rsds.org/somatosensory-rehabilitation-allodynia/
This is just a start for gentle desensitisation. Your professional medical support team will have many more ideas and exercises.