CRPS & Chronic Pain Intensives

Overview

Complex Regional Pain Syndrome (CRPS), formerly known as Reflex Sympathetic Dystrophy (RSD), is a chronic neuro-inflammatory disorder. 

It is classified as a rare disorder by the United States Food and Drug Administration. However, up to 200,000 individuals experience this condition in the United States, alone, in any given year.

CRPS is a form of chronic pain that usually affects an arm or a leg.  The reality is - CRPS can occur anywhere in the body.  CRPS generally follows a musculoskeletal injury, a nerve injury, surgery or immobilization, but it can also follow a sprain or strain.  The pain is out of proportion to the severity of the initial injury.

CRPS is uncommon, and its cause isn't clearly understood. Treatment is most effective when started early. Yet, it can take some patients years to get a diagnosis.  

CRPS occurs when the nervous system and the immune system malfunction as they respond to tissue damage from trauma. The nerves misfire, sending constant pain signals to the brain.   Essentially, think of it as the perfect storm in the brain.

The level of pain is measured as one of the most severe on the McGill University Pain Scale.  Most patients describe it as a burning, stabbing, gnawing pain.

The symptoms of CRPS can greatly impact the function of your affected limb or area, sleep, daily activities and overall mental health.

The persistent pain and disability associated with CRPS require coordinated / patient-centered care to achieve pain reduction and better function.  

While there is no cure at this time - it is possible to gain long-term remission. 

Symptoms

Signs and symptoms of CRPS include:

• Continuous burning or throbbing pain, usually in the arm, leg, hand or foot (in affected area)
• Sensitivity to touch, cold or heat
• Swelling of the painful/affected area(s)
• Changes in skin temperature — alternating between sweaty and cold
• Changes in skin color, ranging from white and blotchy to red or blue
• Changes in skin texture, which may become tender, thin or shiny in the affected area
• Changes in hair and nail growth
• Joint stiffness, swelling and damage
• Muscle spasms, tremors and weakness (atrophy)
• Decreased ability to move the affected body part

Symptoms may change over time and vary from person to person.  Pain, swelling, redness, noticeable changes in temperature and hypersensitivity (particularly to cold &/or hot and touch).

Over time, the affected area can become cold and pale. It may undergo skin and nail changes as well as muscle spasms and tightening. Once these changes occur, the condition is often irreversible.

CRPS occasionally may spread from its source to elsewhere in the body, such as the opposite limb.

Causes

The cause of CRPS isn't completely understood. It's thought to be caused by an injury to or difference in the peripheral and central nervous systems.  

CRPS occurs when the nervous system and the immune system malfunction as they respond to tissue damage from trauma. The nerves misfire, sending constant pain signals to the brain.   Essentially, think of it as the perfect storm in the brain.  [Think of it as malware in the brain.]

CRPS occurs in two types, with similar signs and symptoms, but different causes:

• Type 1 - Also known as reflex sympathetic dystrophy (RSD), this type occurs after an illness or injury that didn't directly damage the nerves in the affected limb. About 90% of people with CRPS have type 1.
• Type 2 - Once referred to as causalgia, this type has symptoms similar to those of type 1, but type 2 CRPS occurs after a distinct nerve injury.

Many cases of CRPS occur after a forceful trauma to an arm or a leg. This can include a crushing injury or a fracture.

Other major and minor traumas — such as surgery, heart attacks, infections and even sprained ankles — also can lead to CRPS.

It's not well understood why these injuries can trigger CRPS.  Not everyone who has such an injury will go on to develop CRPS. It might be due to an interaction between your central and peripheral nervous systems that isn't typical and different inflammatory responses.

How is CRPS diagnosed?

Since CRPS is rare and healthcare providers don’t totally understand it, it’s often misdiagnosed.

There’s no specific test to diagnose CRPS. Healthcare providers mainly diagnose it through a careful medical history, physical examination and review of your symptoms. Your provider will ask you if you’ve had a recent injury or surgery.

Your provider may also order other tests to rule out other diagnoses/conditions that cause similar symptoms. For example, electromyography (EMG) may reveal other causes of neuropathy, which may result in some similar pain scenarios.

Once other possible diagnoses are ruled out, your provider will us the Budapest criteria to make the diagnosis.  

Budapest criteria for CRPS

There are currently no medical tests for Complex Regional Pain Syndrome (CRPS).  A clinical diagnosis is based entirely upon an accepted set of guidelines.  At a medical conference in 2004, the International Association for the Study of Pain (IASP) adopted a new set of guidelines for diagnosing CRPS, superseding guidelines which had been in place for the previous decade.  As the conference took place in Budapest, the new guidelines were named the Budapest Criteria.

Signs and Symptoms

The Budapest Criteria differentiates between ‘signs’, which are seen or felt by the person carrying out the examination and ‘symptoms’ which are reported by the patient.

Symptoms

Under the Budapest Criteria, for a diagnosis of CRPS, a patient must have at least one symptom in three of the following four categories:

• Sensory: hyperaesthesia (an abnormal increase in sensitivity) and/or allodynia (pain caused by usually non-painful stimuli);
• Vasomotor: skin colour changes or temperature and/or skin colour changes between the limbs;
• Sudomotor/oedema: oedema (swelling) and/or sweating changes and/or sweating differences between the limbs;
• Motor/trophic: decreased range of motion and/or motor dysfunction (weakness, tremor, muscular spasm (dystonia)) and/or trophic changes (changes to the hair and/or nail and/or skin on the limb).

Signs

At the time of clinical examination, at least one sign must be present in two or more of the following categories:

• Sensory: hyperalgesia (to pinprick) and/or allodynia (to light touch and/or deep somatic (physical) pressure and/or joint movement);
• Vasomotor: temperature differences between the limb and/or skin colour changes and/or skin colour changes between the limb;
• Sudomotor/oedema: oedema and/or sweating changes and/or sweating differences between the limbs;
• Motor/trophic: decreased range of motion and/or motor dysfunction (ie weakness, tremor or muscle spasm) and/or trophic changes (hair and/or nail and/or skin changes).

Finally, it is important that no other diagnosis can explain the signs and symptoms.

While a diagnosis is fundamental if appropriate treatment is to be obtained, a common diagnostic problem is that not all symptoms and signs are always present at the same time.

Treatments

In traditional allopathic medicine they will look at the following treatments:

• PT or OT
• Medications
  • Gabapentin or Lyrica
  • NSAIDS
  • Anti-depressants
  • Muscle Relaxants
  • Opioids
• Blocks
• Spinal Cord Stimulators
• Nerve Ablation
• Pain Pumps

The Problem

Most CRPS patients are not getting relief from traditional allopathic treatments.  As a matter of fact – most CRPS patients are getting worse with traditional treatments.

Just treating the symptoms is not working.  Then the patients are left feeling hopeless.  

CRPS is not a sprain, strain or fracture.  The body will typically heal in 6-8 weeks following a surgery, fracture or injury.  CRPS surpasses the initial injury and healing process - CRPS persists.  Therefore, it must be treated with a different approach.

Effectively Treating CRPS

You need a top-down approach.

• Start with the Brain

Biology & Physiology of the Body

• Understand the biology and physiology of the human body.
• How does it work…
• Know that the brain controls every aspect of the body – including pain.

Biology of Pain

• With CRPS or chronic pain: The brain perceives ongoing danger, and the pain pathways are reinforced instead of inhibited. 
• The pain response is enhanced in the brain, the spinal cord and the peripheral tissue. 
• These processes are reinforced with continued signaling from the periphery to the brain and the brain back to the periphery. A loop is set up and pain causes more pain, even if the original injury heals

Treating the Whole Person

• Physically, Mentally & Emotionally

A holistic approach to treating CRPS ultimately means treating the whole person.  

This includes addressing:

• Fight / Flight
• The Vagus Nerve
• Balancing the autonomic nervous system (ANS)
• Breaking the pain loop
• Addressing co-existing conditions
• Reducing and managing – stress, anxiety and depression
• Increasing restorative sleep
• Increasing overall sense of wellbeing
• Providing patients with the tools to live a fulfilled life.

This is how the body can heal.

Think of our multi-modality protocol as a blueprint that is individualized to meet your specific needs and goals.   

Holistic Centered Treatment is the only program created by a CRPS survivor.  Unlike other programs – we can truly say we understand CRPS.

I believe that causing pain actually pushes the body further into fight/flight.  

This is what makes us different and allows us to see remarkable changes in our patients. 

Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. Researchers believe that fibromyalgia amplifies painful sensations by affecting the way your brain processes pain signals.

Symptoms sometimes begin after a physical trauma, surgery, infection or significant psychological stress. In other cases, symptoms gradually accumulate over time with no single triggering event.

Women are more likely to develop fibromyalgia than are men. Many people who have fibromyalgia also have tension headaches, temporomandibular joint (TMJ) disorders, irritable bowel syndrome, anxiety and depression.

While there is no cure for fibromyalgia -  it is possible to gain long-term remission. 

 Phantom pain is pain that feels like it's coming from a body part that's no longer there. Doctors once believed this post-amputation phenomenon was a psychological problem, but experts now recognize that these real sensations originate in the spinal cord and brain.

Most people who've had a limb removed report that it sometimes feels as if the amputated limb is still there. This painless phenomenon, known as phantom limb sensation, isn't the same as phantom pain.

For some people, phantom pain gets better over time without treatment. For others, managing phantom pain can be challenging. 

Utilizing an integrative treatment plan that addresses the mind-body connection as proven effective in treating phantom limb pain.