Objectives  Define CRPS  Types of CRPS  Symptoms associated with CRPS  Role of Physical Therapy  PT Intervention  Other treatments options for pain management  Conclusion

What is CRPS ?  Complex Regional Pain Syndrome is a chronic pain disorder. CRPS generally involves a dysfunctional response of the nervous system and may develop after a traumatic injury or a period of immobilization.  CRPS is divided into two categories: Type I (formerly known as Reflex Sympathetic Dystrophy) and Type II (formerly known as Causalgia).

Two Types of CRPS:  CRPS I: Used to be known as reflex sympathetic dystrophy. Is frequently triggered by tissue injury; the term describes all patients with the above symptoms but with no underlying nerve injury.  CRPS II: Used to be known as causalgia. Patients experience the same symptoms but their cases are clearly associated with a nerve injury.

CRPS Diagram

Other names associated with CRPS:  Reflex Sympathetic Dystrophy (previous name for CRPS)  Reflex Neurovascular Dystrophy  Amplified Musculoskeletal Pain

Symptoms of CRPS: CRPS most often affects one of the extremities (arms, legs, hands, or feet) and is also often accompanied by:  Constant Pain  Burning or stinging pain  Increased skin sensitivity: pain caused by things that do not usually cause pain, such as clothing, wind, cold or a light touch to the skin  Changes in skin temperature: warmer or cooler compared to the opposite extremity

Symptoms of CRPS:  Trophic Symptoms  Changes in skin color: often blotchy, purple, pale, or red  Changes in skin texture: shiny and thin, and sometimes excessively sweaty  Changes in nail and hair growth patterns  Thinning of the bones  Swelling and stiffness in affected joints  Motor disability, with decreased ability to move the affected body part

Other Symptoms:  Tremors  Depression or anxiety  Sleep problems

Physical Therapy:  Early physical therapy is essential to avoid atrophy and contractures of the affected limb  PT/ OT have been shown to reduce pain and motor impairment, improve function and coordination ability of the limb  CRPS treatment strategy is usually multi-disciplinary, with the use of different types of medications combined with specific physical therapies.

PT Intervention:  Physical therapy plays an important role in overcoming kinesiophobia and facilitating active movement.  Aggressive mobilizations and strengthening programs should be avoided as they may contribute to the development and maintenance of kinesiophobia.  The interaction between pain severity, pain related fear and kinesiophobia is critical for understanding the complexity of persons with chronic pain syndromes.  There is even evidence that pain related fear can be more disabling than pain itself.

PT Intervention:  Physical therapy should include gentle range of motion exercises within patients’ tolerance levels.  Gradually increasing range of motion, strength and flexibility are important parameters to eventually improve or restore functionality.  Frequent desensitization exercises.  Aquatic physical therapy may be useful to stimulate weight bearing for patients with lower extremity CRPS.  Posture correction may be necessary.

PT Intervention:  Stretching  Strengthening ex: mat exercises such as Feldenkrais techniques  Weight Bearing  Desensitization exercises ex: rub skin with different materials  Aquatic Therapy  TENS  Contrast Bath  Pacing  Relaxation techniques

Other Treatments:  Pharmacologic therapy  Sympathetic nerve block  Spinal cord stimulation  Sympathectomy  Intrathecal drug pump  Psychological therapy ex: pain coping skills and stress management

Conclusion:  The overall role of the therapist during rehabilitation of CRPS is to guide the patient through a program designed to minimize pain and edema while maximizing functional use of the extremity. As CRPS varies greatly in severity and duration, it is very important for the therapist to demonstrate enthusiasm, support and encouragement of the patient during the treatment process.

Questions

References:         mpathetic_dystrophy.htm