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Complex Regional Pain Syndrome




Jeff Giulietti
Jeff Giulietti,
MPT, ATC, OCS, CSCS, COMT, FAAAOMPT



Michale Young
Michael Young, DPT, OCS, CSCS


Eugene Physical Therapy

Eugene Physical Therapy has expertise in treating this Complex Regional Pain Syndrome (CPRS), formerly known as Reflex Sympathetic Dystrophy Syndrome (RSDS). If you are a patient who is reading this, make certain you commit to reading this from beginning to end, as this is a complicated topic. The description is summarized in simple terms patients can understand and additionally for referring physicians who may wish to learn more about our effective treatment program.

WHAT IS IT?
A painful disorder that affects the upper or lower extremity, characterized by severe pain often described as "burning", marked limitation in function, altered sensation (i.e. hypersensitivity or hyposensitivity), gait dysfunction with the lower extremity, altered movement patterns in the upper extremity. Anxiety can often be associated with this problem.

In short this problem has 3 components:
  1. Injury to a lower extremity or upper extremity
  2. Overlapping spine (cervical or lumbar) nerve problem with the patient generally not knowing it
  3. A brain problem that can be in fight/flight, confusion, anxiety, and a host of possibilities as a result of unintentionally making choices that are making the condition worse.
A peripheral injury, a spine problem, a brain problem. What is critical to understand, is that there is always, 100% of the time, a spine component in a CRPS case, whether or not the patient realizes it. In 1994 this diagnosis had a name change from Reflex Sympathetic Dystrophy Syndrome (RSDS) to now CRPS to help standardize research. Those cases where EMG (Electromyography) testing was normal are classified as CRPS I, and EMG positive findings are classified as CRPS II. (reference). The reason for this diagnosis formerly called "Reflex Sympathetic" is that the sympathetic nervous system, specifically the nerve plexus on the lateral thoracic spine becomes involves which also regulates pain into the upper and lower extremity. Therefore the spine component. The majority of patients with CRPS do not recognize they have a spinal contributor to pain.

Imagine you have an ankle sprain that simply is not managed in the best of light. Instead of optimally taking care of the sprain, ankle brace, crutches, icing to get the swelling down, resting to allow ligaments to heal, accidents happen and the condition worsens. Then, either a past back problem becomes activated, or a new one begins, from the very process of limping and straining the lumbar spine abnormally. Over time, now we have a thoracic and lumbar problem with a nerve problem. That means 2 reasons for pain. It is now double. Now the brain goes into fight/flight, which changes neurochemical transmitters (chemicals in your brain) that literally make nerve tissue more excitable. Specifically your nerves become "hypersensitive". Now your pain is triple.

Welcome to the land of CRPS
A patient who is willing to learn about how to treat these above 3 components will improve.

REFERENCES:
Wilson PR, Hicks M, Harden RN CRPS: Current Diagnosis and Therapy
     IASP. 1994

Merskey, Bogduk N Chronic Pain: Descriptions of Chronic Pain Syndromes and Definitions of Pain Terms
     2nd ed. Seattle IASP Press 1994.