Complex Regional Pain Syndrome

Physical Therapy for Complex Region Pain Syndrome

Photo of a woman at work holding her neck.
CRPS does not have to keep you from doing your normal activity. Thomas_EyeDesign/Getty Images

Complex regional pain syndrome, or CRPS, is a painful condition that affects the arms or legs after some form of injury has occurred. CRPS is a diagnosis of exclusion and is characterized by severe pain out of proportion to the initial event. It is also associated with swelling, temperature change, and touch sensitivity of the affected extremity. The symptoms seem to come on gradually over a period of time after an injury or surgery.

Two types of CRPS exist. Type one occurs in the absence of nerve injury while type two occurs after damage to a nerve in the injured arm or leg. Three mandatory diagnostic criteria for the condition of CRPS are described by the International Association for the Study of Pain consensus panel. These include:

  • Continuing pain of the arm or leg disproportionate to the initiating event
  • Pain associated with changes in skin blood flow, swelling, or abnormal sweating
  • No evidence of another condition that could account for the pain or dysfunction

The pain felt with CRPS is out of proportion in intensity, distribution, and duration of what would be expected from the initial injury. The nature of the pain often fluctuates with external stimuli (changes in temperature/touch) and internal stimuli (life stress/illness). Eventually movement can become limited due to pain and muscle weakness and decreased range of motion develops in the affected arm or leg.

Physical Therapy for Complex Region Pain Syndrome

Physical therapy plays an important role in the management of CPRS. Common physical therapy goals in this disorder include:

    Your physical therapist can help you improve the way your arm or leg functions if you have CRPS. Movement and exercise are important components of a rehab program for CRPS, but the exercises need to be progressive in nature. They should start out gentle and slow; too much, too soon can increase your pain level and decrease your overall mobility level. The goal of exercise for CRPS is to teach your brain that you can move your body safely with no increased threat to the tissues involved. Moving your hand may hurt if your have CRPS, but the over effect of the motion should not cause any harm. Performing this exercise regularly can reinforce the safety of motion and exercise for CRPS, allowing you to gradually tolerate more and more motion and exercise with less pain.

    Graded Motor Imagery for CRPS

    A relatively new treatment for CRPS is called graded motor imagery. During this regimen, specific exercises are done to retrain your brain to recognize your injured body part as a normal, functional and useful part of your body.

    There are three stages to graded motor imagery training, including:

    • Left/right discrimination
    • Explicit motor imagery
    • Mirror therapy

    These stages are done to retrain your brain to recognize and accept your painful body part as a normal functioning part, with no threat of pain or damage being done to the body.

    CRPS is a difficult disorder to treat. However with the right  physical therapy and medical management, a decrease in the pain intensity and functional improvement can occur. That way, you can get back to your normal activity level quickly and safely.

    Complex regional pain syndrome (CRPS) with resistance to local anesthetic block: a case report . Journal of Clinical Anesthesia , Volume 12 , Issue 1 , Pages 67 - 71 F. Maneksha.

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