Complex Regional Pain Syndrome (CRPS): Tips from An Occupational Therapist

Complex Regional Pain Syndrome (CRPS) Tips From An Occupational Therapist

Probably one of the most complicated situations that we see in a rehab setting is a condition called the Complex Regional Pain Syndrome or the CRPS. It has many different names, but it's thought of as something related to a traumatic event which aggravates the sympathetic nervous system. And that can cause extreme pain to the patient. The pain is actually way more intense than the actual injury itself.

From my past experience, as an occupational therapist, some patients told me that there are doctors who told them that they made their pain up and that they didn't have any pain. There are also people saying that it was just their imagination. And I would like to just to say that you cannot just make up what you are experiencing, it's true. We acknowledge that. And we are to assure you that there are available solutions for your pain.

 
This is also a very challenging situation. CRPS does not follow a specific pattern, it doesn't follow a nerve root pattern, a dermatome myotome or any neurological examination that can categorize which makes it harder to be diagnosed.

It has different types of symptoms because the sympathetic nervous systems are involved. Some of the symptoms may include the hotness or coldness of a patient's hands or in some cases, the color changes into red or blue. That’s because some blood circulation is affected. It may also include extreme swelling, hair loss, hair growth, or nail losses, nail growth, but it’s very different in presentation.

 

Oftentimes, they have a lot of joint stiffness that they cannot move or it has a lot of range in motion which is mainly stopped by pain. But they can’t link it to any traumatic event that's specific or relevant to that situation.


The mechanism of injury can be very erratic and irrelevant to look like which is why it's hard for them to be diagnosed and be treated early. That is the reason why a lot of the treatment doesn't show as much of a research findings or effective treatment to treat this condition. Because they probably already failed. And when all of these patients are finally being categorized or diagnosed into CRPS, it’s already a little too late, which is sadly, one of the limitations the medical field is currently experiencing.

There are two lady patients I've been seeing lately. The first one, she just randomly had a thumb pain. She woke up one day, and the only thing she can remember was she had a long car ride during a road trip, which is not a traumatic event. But then, her thumb flared up very bad.


She described it as a 10 out of 10 in pain. And also, she described it as if she couldn't move her thumb or wrist at all. And when she came in, I felt that her hand was extremely hot and it looks red, it looks very swollen and the range of motion was very limited, which is the most typical presentation of the syndrome.

 
We did one session, talking a lot about stress and which one is the most common treatment approach. To handle this condition and adjust within one session, we are able to help her and drop her pain from 10 to 3 out of 10.

 

Then the next time she comes in, her range of motion was back to almost normal like 80% or 90%. To her other side of the hand, which has an extremely better result in just one session. Because of early recognition, she came in the next day or two days later, we were able to start a treatment quickly. We were able to take care of her condition immediately. 


A lot of the reason why CRPS is a very challenging situation is because most of the patients who finally receive the proper treatment, it's already after four or five months or years later, which already made the condition very chronic and hard to deal with. So, early recognition and early treatment is the key to effectively manage CRPS. 

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The second lady mentioned to me that she went through a lot of hassles before finally diagnosing to having a CRPS. Her presentation wasn't very typical, her doctor said that she didn't lose her nails and she didn't look like having a CRPS. But eventually, she got diagnosed with the syndrome. But that was already several months later when she went to a clinic. And the only treatment she was doing was desensitization.

Desensitization doesn’t work. They pretty much just discharged her saying that PT cannot help her. So just letting her to do whatever she can to manage that by herself. CRPS has a very different presentation and different situation than many other conditions. It's the sympathetic nervous system being affected, which means the treatment is a little different. 

If you just do regular desensitization program that many clinics offers, it's probably not that effective. The nerves are using different tracks. Normal desensitization program would actually make the condition worse. By making it worse, you are already making an angry nervous system to be even angrier by doing inappropriate treatment.

The proper treatment is actually putting a lot of stress to the joint and giving it enough of a stress sensation. We call that the deep pressure sensation, which uses a totally different nerve pathway into the brain, and helps you to inhibit the pain more effectively. This is the method I used with the Second Lady.

Then, she said that things would be way different if she had just found the right provider on the first time. This condition may be challenging, but there are clinicians who are capable of dealing with this. That can provide you a treatment so you can do better versus wasting months or years of your time suffering from a range of 10 in pain every single day.

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