CRPS: Complex Regional Pain Syndrome
CRPS is a pain disorder that causes a range of symptoms in one area of the body. It can be brought on by injury or restriction, like a twisted ankle or sling. Alternatively, it can follow a nerve injury. Symptoms may be acute (despite the name), resolving in under 3 months, or chronic. Most cases resolve within 18 months.
Symptoms of CRPS
CRPS affects all ages past childhood, with women more likely to be affected than men. It is more common in the leg than the arm, and its incidence peaks in the late 30s to 40s. It develops within days weeks of an injury, or restriction such as using a sling or needing a plaster cast. Typically the symptoms are confined to one area, but they have been reported symmetrically between limbs. Frozen shoulder can develop alongside symptoms in the hand or arm, which is maybe not so surprising when both can follow a period of restriction.
Alongside symptoms of heightened pain, there are signs visible to other people. The affected area may be visibly swollen, red, and it may be warmer or colder than surrounding skin. Where a hand or foot is involved, there may even be changes to the growth of nails.
Diagnosing CRPS
As with other pain conditions like fibromyalgia, diagnosis requires a ruling out of other conditions. Neuralgia following trauma can present very similarly, and if the leg is affected it may look like sciatica.
WIth other possible explanations disproven, the diagnostic criteria for CRPS includes disproportionate ongoing pain. There must also be a range of signs and symptoms in the following categories:
Heightened pain to stimuli that are normally painful or non-painful
Colour and temperature changes to skin
Changes or asymmetry to sweating or swelling
Altered movement (restriction, tremor, weakness) or changes to hair or nails
Although your osteopath will be aware of these criteria, we cannot give a formal diagnosis of CRPS. Instead, we can refer you back to your GP, with a letter outlining our thoughts if you’d like. The best results in treatment come from a multidisciplinary team, so it’s important that you’re in the medical system and able to access any additional referrals.
Management
There are a range of medications that may help with the signs and symptoms. Physiotherapy has been recognised as “vital for the success” of treatment of CRPS. Physical therapy and occupational therapy are also listed as key parts of the management strategy. Alongside the usual techniques your osteopath would use for pain, desensitising techniques, mirrored and imagined movements are helpful. These methods often come up with pain conditions, as they help to retrain the nervous system and let it realise that these movements are safe.
As always, we will look at how the body is compensating for your pain. It’s not unusual for the affected limb to be “neglected”, meaning you almost forget to use it. As a result, compensatory patterns can be particularly stark, causing muscles and joints to work harder than they normally would throughout the body. Whole body treatment may make up a part of your treatment plan, alongside exercises prescribed for you based on your current ability.