Struggling with ongoing pain? As physiotherapists, this is an area we take very seriously, understanding the effect it has on the day-to-day lives of our patients. To help, here’s a deeper look into complex regional pain syndrome and how we work with those affected.
Summary
Complex regional pain syndrome (CRPS) describes long-lasting pain (with or without inflammation) that most often affects an arm, leg, hand or foot.[1] CRPS is caused by problems with the nervous system, meaning the nerves in either your central nervous system (brain and spinal cord) or peripheral nervous system (the nerves that extend from your spine to the rest of your body) become damaged or malfunction.
Like the name implies, the process behind the pain of CRPS is complex and often difficult to understand, attribute or classify. It can also vary greatly from person to person. While this makes the exact causative mechanism difficult to explain, what is medically confirmed is that the result of CRPS is severe, persistent and debilitating pain that is often very limiting to those affected.
What is CRPS?
CRPS is a chronic pain condition where the pain response becomes exaggerated, almost like the body’s alarm system gets stuck on high alert. The level of pain a person with CRPS experiences often doesn’t match the injury that caused it, frustratingly lasting notably longer than expected for the typical healing process. And here’s what makes it tricky: the pain isn’t just from the original injury, but because the nervous system is continuing to fire off pain signals, even when there’s no ongoing damage.
Complex regional pain syndrome is classified into two types based on whether or not there is an identified nerve injury:
- CRPS-I occurs after illness or injury, but with no confirmed nerve injury
- CRPS-II: where there is a known injury to a nerve
In most cases, CRPS is triggered by an injury or an event, such as bone fractures, muscle injuries, sprains, burns, surgery, or periods of immobilisation in a cast. Medical events like heart attacks, strokes, cancer, infection, emotional stress and an overreaction of the immune system may also play a role. With this said, it remains unclear why some people with specific injuries will go on to develop CRPS, and others with the same injury don’t. CRPS may develop gradually or slowly, can vary in severity, and occurs at a higher rate in women than men, especially between the ages of 40 and 50 years.[2]
Symptoms of Complex Regional Pain Syndrome
A sign of CRPS noted among health professionals is the confusion expressed by patients about how “it doesn’t make sense,” as the initial injury is nowhere near as severe as the symptoms they are now experiencing. CRPS can be either acute (short-term) or chronic, lasting more than 6 months.
Both types of CRPS can result in similar symptoms, and both can respond to the right care, especially when treatment is not delayed. Alongside ongoing and severe pain, changes to pain with activity, and limitations in the movement of the affected area, as well as nerve-related symptoms can also present, including:[3]
- Burning
- Tinging
- Pins and needles
- Numbness
- Sensitivity to touch and temperature
- Excessive sweating
- Changes to the skin colour and appearance (thin, shiny, sweaty skin)
- Muscle weakness or tremors over time
How Can Physiotherapy Help With CRPS?
When managing complex pain, physiotherapy care helps support your functional rehabilitation, which involves keeping the affected limbs moving, maintaining good movement and flexibility, and promoting a person’s overall fitness, health and well-being.
Our goal is to help you relieve and manage your symptoms, allowing you to live comfortably and independently, while preparing you best for long-term mobility, function, and health. This is achieved through a tailored program that is specifically designed to address your symptoms, goals, and the current impact of CRPS on your life. Every client receives a personalised management plan grounded in a few key principles:
1. Education and Empowerment
Understanding what’s happening in your body is a big part of helping calm the nervous system. You’ll have a better idea of what’s going on (in your specific circumstances), what you can expect, and what your rehabilitation path looks like.
2. Graded Movement and Desensitisation
Some patients find even gentle touch unbearable in terms of pain levels. We’ll start slowly, meeting you where you’re at, with gentle movements and carefully graded exposure to help retrain the brain’s response to sensation and movement.
3. Restoring Function and Strength
As symptoms ease, we’ll help you build up your movement, mobility, and strength. We achieve this through mobilisation, isometric strengthening, and a program designed to help you return to regular function as closely as possible. This is all tailored to how you’re responding - some people need more support with joint stiffness, while others require assistance with muscle wastage or coordination. No two CRPS journeys are the same, so we don’t take a one-size-fits-all approach.
4. Supporting the Whole Person
CRPS doesn’t just affect the body, but also your confidence, mood, and daily life. We work together in partnership to support recovery in a way that makes sense for you and your lifestyle.
We may also recommend one or more of the following as part of your management plan:
- Pain management modalities
- Stress management and relaxation techniques
- Massage or acupuncture (dry needling)
- Clinical Pilates
- Hydrotherapy
- Specific exercises to help you continue to perform your daily activities
- Referral to occupational therapy or other health disciplines.
What Is The Outlook For CRPS?
While the recovery period and progress for CRPS can vary greatly from person to person (making predicting outcomes difficult), it is possible to help reduce and manage the pain. Research shows that early treatment in the first three months may yield the most promising results. Without proper care, CRPS may spread to other areas of the body, lead to tissue wastage or muscle tightness, or persist as an ongoing problem for a long time.
If you’re dealing with CRPS or ongoing severe pain, the best time to start your care is now, with an experienced physiotherapy team. At PhysioCentral, we’re here to help.
Book your appointment by calling us at +852 2801 4801 or book online here.