Complex Regional Pain Syndrome
Complex Regional Pain Syndrome (CRPS) is a rare but debilitating chronic pain that most frequently affects the upper and lower extremities. CRPS isn’t life-threatening but it can significantly impact one’s quality of life, making it challenging for those affected to live a functional life.
CRPS typically follows a trauma to the limbs, such as a fracture, sprain, or surgery and can also develop post stroke or heart attack. The clinical presentation and disease course of CRPS both vary person to person. CRPS is divided into two groups:
- Type 1 (sympathetic dystrophy) develops without known nerve damage
- Type 2 (causalgia) is the result of specific nerve damage
How do we treat CRPS at Complete Balance?
In Traditional Chinese Medicine (TCM), Complex Regional Pain Syndrome (CRPS) is understood as a disruption in the flow of Qi (energy) and Blood in the affected area, resulting in pain and dysfunction. TCM theory attributes CRPS to stagnation of Qi and Blood and blockages in the meridians (energy channels) within the affected limb or body part. Impaired Qi and Blood flow can lead to hypoxia-induced inflammation and fascial restrictions around blood vessels and nerve endings, exacerbating pain and disrupting proprioceptive function. TCM treatments focus on restoring the smooth flow of Qi and Blood, balancing internal energies, and alleviating pain.
Acupuncture is well-regarded for pain management, but treating chronic conditions like CRPS also requires a comprehensive approach to overall organ health. For instance, if the heart and lungs are unable to effectively circulate oxygenated blood, it may lead to Qi and Blood deficiency, hindering nerve repair. Similarly, Liver dysfunction due to poor diet, stress, or genetic factors can constrict blood vessels and impair circulation. Addressing these factors holistically is crucial for effective treatment.
Acupuncture and moxibustion are beneficial for enhancing blood flow, increasing fascia flexibility, and relieving restrictions that contribute to CRPS symptoms. Scalp acupuncture specifically stimulates and restores nerve pathways, aiding in nerve regeneration. For cases of nerve damage or reduced sensation, these treatments enhance blood flow to re-activate and protect nerve fibers. In patients with a weakened constitution, moxibustion, herbal remedies, and supplements are used to boost overall energy levels. Post-acupuncture physical therapy focuses on correcting gait, movement, and postural issues, while manual therapy helps to manage pain. Chiropractic adjustments may also be necessary to correct spinal misalignments and improve circulation. The goal of these treatments is to reduce inflammation, restore nerve function, eliminate blockages, alleviate pain, improve circulation, enhance organ function, correct misalignments, and optimize motor function.
Achieving a positive prognosis for CRPS requires incorporating lifestyle changes such as behavioural adjustments, dietary modifications, and a shift in perspective towards one’s condition.
The main symptoms are extreme pain out of proportion to the initial injury (allodynia), increased pain response to mild stimulus (hyperalgesia), loss of range of motion, muscle weakness, temperature changes, swelling/edema, and discoloration of the skin. Psychiatric disorders such as insomnia, substance abuse, anxiety, mood & personality disorder can be comorbid with CRPS due to ongoing suffering of the patient. Pain sensation often expressed by CRPS patients are burning, throbbing, shooting, aching, and squeezing pressure. Pain is generally localized at the site of initial injury but can affect the entire limb and in rare cases, the limb on the opposite side. CRPS can also appear spontaneously after an individual goes through increased emotional stress.
CRPS generally begins with an injury to the limbs but the chronic and worsening nature of the disease stems from multifactorial pathophysiological etiology that includes weak blood flow, unrelieved inflammation, autoimmune responses, abnormal cytokine production, autonomic dysfunction, psychological factors, and central cortical reorganization.(footnote) There are no specific laboratory diagnostic tools for CRPS, and so it is diagnosed clinically. The Budapest criteria is currently the most-accepted diagnostic criteria.
Western medicine generally struggles with CRPS, as treatments like pain medications and physical therapy often provide limited improvement in long-term outcomes. While medications can alleviate symptoms of peripheral neuropathy, they do not halt the disease’s progression and may come with unpleasant side effects. This approach frequently results in severe pain, disability, and a poor prognosis, severely impacting patients’ quality of life. Early diagnosis and prompt treatment are essential for potentially improving disease management and patient well-being.
Noninvasive treatments for CRPS include:
- Medication: A range of drugs may be prescribed to address CRPS symptoms, such as pain relievers (both prescription and over-the-counter), steroids for inflammation, blood pressure medications, bone loss preventatives, and antidepressants.
- Physical or Occupational Therapy: Regular exercise and movement of the affected limb are crucial for maintaining flexibility and preventing muscle atrophy.
- Counselling and Talk Therapy: Psychological support is important for managing depression and anxiety often associated with CRPS.
Invasive and surgical treatments for CRPS include:
- Anesthetics: Injected directly into the affected limb to numb pain.
- Sympathetic Ganglion Block: An injection targeting the “fight or flight” nerves to reduce swelling and pain.
- Spinal Cord Stimulator: A device that delivers a tingling or pleasant sensation to mask pain.
- Surgery: Involves cutting affected nerves to block painful impulses from reaching the brain, typically used for the most severe cases of CRPS.