The CRPS clinic at Specialist Pain Physio is a speciality clinic linking with pain consultants and pain psychology to offer modern and evidence-based treatment.
There are two types of Complex Regional Pain Syndrome: Type I (Reflex Sympathetic Dystrophy, RSD) that develops following a minor injury or fracture of the limb and Type II (Causalgia) that follows an injury to a peripheral nerve.
The diagnosis of CRPS is based upon the clinical presentation as there are no objective tools or gold standard. Below are listed the common changes and abnormalities in sensory processing, autonomic nervous system control, trophic and motor changes.
- Continuous burning pain
- Spontaneous pain
- Pain disproportionate in intensity to inciting event, often increasing when the limb is in the dependent position
- Pain evoked by touch (including light touch, i.e. allodynia), temperature change, movement and touch applied to joints (deep somatic allodynia)
- Changes in sensation that are changeable and lack consistency
- Swelling
- Changes in sweating
- Colour changes (vasoconstriction, vasodilation)
- Changes in skin temperature
- Abnormal nail and hair growth
- Fibrosis
- Thin, glossy skin
- Osteoporosis
- Weakness, tremor, dystonia
- Poor coordination of movement
- Neglect & denial
There can be several pain mechanisms that are underlying the symptoms, including neuropathic pain and inflammatory pain (neurogenic inflammtion). Determining the mechanism allows for the selection of the most appropriate treatment.
Currently the best method of treatment of this condition applies the biopsychosocial model of care. Stanton-Hicks developed a framework that integrates physiotherapy, medical and psychological care for CRPS. The physiotherapy aspect often includes education, reassurance, desensitising techniques and gradual reactivation. More recently Graded Motor Imagery has been introduced following the work of Lorimer Moseley. The evidence supports this approach that is grounded in the field of pain science.
At Specialist Pain Physio the Graded Motor Imagery Programme is used within the biopsychosocial model of care. These techniques are applied alongside a range of other interventions and management strategies that aim to restore function, reduce pain, improve control and enhance quality of life. We continue to work closely with those in the field who are driving our knowledge about CRPS and its management forwards.