Complex Regional Pain Syndrome

(formerly known as Reflex Sympathetic Dystrophy)

Complex Regional Pain Syndrome (CRPS) occurs after a trauma to the distal part of the extremity or after direct injury to the nerve. CRPS is associated with distal extremity pain and swelling, with the pain being disproportionate in time and degree to the injury. Patients may also have increased blood flow and swelling, abnormal hair/nail growth, loss of motion, and weakness. This is a classic example of what happens with chronic pain. The initiating event led to a sensitization of the nervous system that is now causing abnormal reactions throughout the limb.

Before we talk about Physical Therapy treatment, let me state that this is one particular case where pharmacological approaches have been well researched and proven extremely effective. Systemically administered antidepressants and anticonvulsants or topical use of capsaicin and lidocaine have been proven to significantly reduce symptoms of CRPS. I have had patients who are frustrated by being placed on an antidepressant because they feel the doctor is saying their pain isn’t “real”. However, the truth is that the antidepressants affect the processing of the pain through the nervous system and have been shown to significantly decrease symptoms. I would strongly recommend that patients discuss all pharmacological options with their doctors so they can find a path that works right for them.

Okay, back to the Physical Therapy stuff! CRPS is a challenging disease that makes slow progress no matter the treatment option. A graded exercise program to return each patient to their desired activity level has proven effective for long term management of CRPS. Along with this, instruction in home TENS use and performance of mirror therapy has proven to be effective in treating CRPS. The goal is to support each patient with pain reduction and making positive steps towards improving range of motion and strength so they can return to their lives.

If I can help you on your path, please feel free to contact Amy at (425)658-4944 or amykonvalinpt@gmail.com.