Complex Regional Pain Syndrome (CRPS) was first recognised during the Civil War, then known as causalgia. Since then the condition has been re-named as Reflex Sympathetic Dystrophy (RSD) and more recently, complex regional pain syndrome or CRPS. CRPS can be a particularly painful and limiting problem that affects quality of life in many ways. The modern biopsychosocial approach that we provide addresses the biology of the pain and other symptoms, the psychological impact, including the influence of stress, anxiety and negative thinking about the condition, and the social effects such as work, home-life and the limits that CRPS can put upon physical activities.
Science-based treatment for CRPS
Modern and on-going research helps us to understand the underpinning biology of CRPS. For example, we know that there are changes throughout the nervous system, including the brain, that create the experience of CRPS. There are local effects in the tissues and altered activity in the nerves and blood vessels that together with the changes in the brain and spinal cord can explain the signs and symptoms. Having a greater understanding means that we can tackle the problem with understanding, desensitising therapies, graded activity and using the latest neuroscience based therapies that target the brain.
Types of CRPS
There are two types of CRPS, type I and type II, the criteria of the International Association for the Study of Pain (IASP)
Type I diagnostic criteria:
- The presence of an initiating noxious event or a cause of immobilization
- Continuing pain, allodynia (perception of pain from a nonpainful stimulus), or hyperalgesia disproportionate to the inciting event
- Evidence at some time of edema, changes in skin blood flow, or abnormal sudomotor activity in the area of pain
- The diagnosis is excluded by the existence of any condition that would otherwise account for the degree of pain and dysfunction
Type II diagnostic criteria:
- The presence of continuing pain, allodynia, or hyperalgesia after a nerve injury, not necessarily limited to the distribution of the injured nerve
- Evidence at some time of edema, changes in skin blood flow, or abnormal sudomotor activity in the region of pain
- The diagnosis is excluded by the existence of any condition that would otherwise account for the degree of pain and dysfunction
** The main difference is the identification of a nerve injury
CRPS Clinic in London
There are a range of signs and symptoms including:
- Pain – this can vary enormously in severity, description, quality, location, pattern
- Altered sensation – numbness, paraesthesia (pins & needles)
- Temperature change – heat, cold
- Size – swelling can vary from minute to minute on occasion; there can also be a sense of swelling that is not apparent when compared to the other side, for example the feeling of ‘sausage fingers’
- Stiffness in the tissues
- Sweating changes (sudomotor)
- Loss of function – reduced strength, position sense, control of movement
- Altered sense of self – limb feels detached, belonging to someone else; these are common feelings and due to changes in the nervous system that creates an altered perception of your body, especially in the affected region
- Other – there are many descriptions that patients give relating to symptoms, feelings, sense and pain and we encourage this expression as this is your unique story
Treatment
Treatment programmes are physiotherapy-led at our clinics. However, if during the assessment or treatment process we identify particular issues that we believe require medical or psychological input, we can arrange this for you swiftly. We work closely with several pain consultants and psychologists who provide excellent care.
Our treatment programmes are designed to promote deep understanding of CRPS, to gradually develop healthy movement and function, to augment a normal sense of the body and to reduce the pain and sensitivity. Science has told us that pain is a brain experience in response to a perceived threat. Tackling this by reducing the threat with informational medicine, giving a meaning to the pain and suffering, validating your experience and providing the latest treatment strategies is our primary concern. This includes neuroscience-based therapies such as the Graded Motor Imagery programme (also click here), sensory training and cognitive techniques, alongside movement and exercise therapies, hands-on treatment when appropriate, effective strategies for day-to-day living, skills to deal with flare-ups and other techniques that focus on the integrated function of body, brain, mind and immune system.
For further information please contact the clinic: 07518 445493
