Major Pain! CRPS (Complex Regional Pain Syndrome)

Let's jump into CRPS (complex regional pain syndrome). It was formerly named RSD (reflex sympathetic dystrophy) and remains relatively unknown. In many expert opinions, it is referred to as being very rare; however, others say it can occur in 9-10% of the population, which is a large number of people. We are going be using two sources for the information that I present below.

The first source we will be referencing from is Mayoclinic.org. It's not complete, as it is not designed to be, but it provides an outline of some of the things found in this article. The second resource we are using is an article from 2014 that was published in the Turkish Journal of Physical Medicine and Rehabilitation: Effects of Low-level Laser Therapy and Interferential Current Therapy in the Treatment of Complex Regional Pain Syndrome.

What is CRPS?

Because many people have never heard of this, let's first address what CRPS is. If you have heard of it, your doctor still may not have. This condition can be difficult to accurately diagnosis for many reasons, so let's first discuss its symptoms.

Symptoms of CRPS

The most common symptom here is severe pain or nerve pain in the extremity. It will feel like a continuous burning or throbbing or pulsing pain, and there can be significant sensitivities to touch or pressure. For example, even air movement can significantly agitate the discomfort, as well as cold temperatures. In many cases, the skin can start looking thinner or shiny or even change color. Patients might either feel a swelling sensation in the area or you experience actual swelling. There may be changes in the joint itself if this goes on for long enough. There might also be changes in hair, fingernail, and toenail growth.

One of the hallmarks of CRPS is that there is pain that is disproportionate to what originally initiated the pain. Now, this takes us to the causes. Although we don't know exactly what is going on in the body of somebody with CRPS, we do know that—with most cases—everyone is going to have a minor, or sometimes major, injury or surgery that occurs. It is then followed by severe amounts of pain that, compared to what one would expect, is disproportionate not only in its duration, but also in its intensity. For example, if you sprain your ankle, you would expect that injury to be feeling pretty good within 8-12 weeks, right? If you sprain your ankle and also have an onset of CRPS afterward, though, you would have severe pain even four months later, which is not normal or anticipated.

In many cases, the symptoms themselves can even change and vary in terms of their intensity. They can change in location, to some degree, and spread to affect the joints nearby. The symptoms' intensity does not stick to the known nerve distributions. This means that when you tell your doctor about this very severe pain where you had an injury, and you describe how it seems to change so much (for instance, that it sometimes spreads in an area that is not usually connected to one particular nerve), unfortunately, most doctors would look at you and go, "yeah, right." Often they will not believe it because it looks like you are making it up or are potentially seeking potent prescriptions. This may seem like an unreasonable response from the patient's perspective, but it is understandable from a clinical perspective because there are very legitimate cases of CRPS that do not fit the typical clinical picture. And, unfortunately, some patients are desperate to get drugs. That is why we at LTI help doctors provide non-pharmaceutical treatment options.

CRPS Nerve Pain

So, what is causing these atypical symptoms?  Most likely, neurogenic inflammation. Neurogenic inflammation is the irritation and inflammation around the nerves. Sometimes this irritation and inflammation is actually sources from the nerves themselves. When you have inflammation on the nerves, there are a few things that happen. One, the nerves misfire. As a result, they start to send signals when they are not supposed to. If that inflammation is in a nerve that sends you pain signals, then that would obviously generate a lot of pain. If that inflammation is in a nerve that controls blood flow to the skin, then you're going to get blood flow changes, color changes, hypersensitivities, and swelling. If the inflammation occurs in the nerves that go to the muscles, then you'll get muscle stiffness, joint stiffness, aching, and spasming. It all comes back to this idea that the nerves themselves are inflamed. Sadly, anti-inflammatories do not bring that type of pain down very well.

Further, without getting too much into the chemistry of how your nerves work, it helps to understand that nerves have a threshold. The nerves are not supposed to send pain signals until they reach that certain level of stimulus which meets that threshold. You do not want every little bump or pressure to feel severely painful, right? That's not how pain nerves are designed to work. They are supposed to let you know when something is really dangerous; but if the nerve becomes inflamed, then that threshold becomes much lower. This means that even small, tiny stimulus will send a pain signal when it otherwise should not be sending those pain signals.

Now, this pain we're referring to is very significant, and the treatments are very poor. That treatments are so poor that there have been two conferences of the International Association for the Study of Pain dedicated to CRPS—but they still have not been able to produce a good therapeutic protocol for this disorder. Just getting the diagnosis can be difficult. When you get a diagnosis of CRPS, it is called a diagnosis of exclusion, which means that there is not a particular test for the disorder. You can not draw blood and test for CRPS, nor can you take an x-ray to know if someone has CRPS. You have to do your testing, end up with nothing, then put all this information together to maybe come out with the diagnosis of CRPS. The doctors are going to have to look at your symptoms along with the absence of other findings to know if CRPS is an accurate diagnosis.

The Reality of CRPS Treatments and Outcomes

Once you have a diagnosis, your treatment options will be limited. Most treatments rely on some medications that can, in some cases, help reduce the pain. . . and always come with side effects. There can be additional, alternative-medicine strategies to try, including acupuncture or physical therapy, which are extremely common. In fact, in the study that we are referring to here, the authors say that physical therapy is the most significant procedure and treatment of CRPS. Physical therapy includes things such as hot packs, interferential current, and mobilization of the soft tissues or joints—when the pain is bearable. The idea behind this treatment is to reduce the amount of nerve irritation and, consequently, get the pain levels under control.

The next aspect of Complex Regional Pain Syndrome to acknowledge is that, a majority of the time, there will be a recurrence of pain. Such pain is often located in a different area, but sometimes in the same area, which can be incredibly frustrating if you are not aware of this likely possibility before attempting treatments. Successfully getting this pain under control is a significant achievement, so to have it flare up again can be depressing and upsetting (and understandably so!). Thoughts like, "I had this nailed down, but now the pain is just as severe as when I started," can be incredibly frustrating. That said, there is no use in being hopeless because, again, there are solutions. Just make sure you understand that every case of CRPS is different, and each CRPS patient responds differently to treatments. Keeping a positive-yet-realistic mindset is an important part of treating this condition, and we encourage you to be open to trying multiple methods of treatment:

• medications

• physical therapy

• chiropractic

• acupuncture

• laser therapy

Laser Therapy for CRPS

We recommend you consider laser therapy and to look for someone who knows how to treat CRPS using laser therapy. In this study we are referring to, the researchers noted that "the application of laser therapy had a particularly beneficial effect in reducing pain, intensity, and edema" and that "no negative effects of the applied therapy were recorded." Obviously, if you can receive an effective therapy without experiencing side effects or negative effects, that is ideal. The researchers go on to say that "laser therapy has specific therapeutic effects such as analgesia [the reduction of pain], anti-edematous [anti-swelling], anti-inflammatory effects, and improvement of regenerative abilities."

This takes us back to the idea that the threshold that these effected nerves are operating at is improper. As previously stated, the nerves are not supposed to send you pain signals until that threshold of stimulus is reached. That is why it does not hurt to touch a desk (at least, it shouldn't hurt). For someone with CRPS, however, brushing up against something or even having a little air pass over the overly sensitive nerves can be extremely painful due to those nerves not operating normally. Laser is specifically reported as having an "influence on the tone of the nervous system with the aim of its normalization." The research also says that it has modulation of pain perception (how your body feels pain) and what that pain signaling is like, as well as increased production of endogenous opioids. These endogenous opioids are your body's own pain-reducing chemicals. The researchers go on to say, "laser therapy blocks the entrance of sodium ions into the cell, which is a stabilizing factor in the cell membrane resting potential." Again, it all goes back to that threshold idea, for which sodium ions are a critical factor: If you do not have the proper balance of sodium ions, then you experience improper signaling (e.g., overly sensitive signals of pain perception). The authors of the study also say that laser "has anti-edematous, anti-inflammatory effects and, by increasing local microcirculation, laser reduces the edema [swelling], increases tissue oxygenation, and facilitates elimination of allogenic substances [substances  that create pain signals]."

Laser Therapy Institute and CRPS

Laser Therapy Institute's protocols are good at helping people with CRPS and reducing their pain. For most CRPS patients, after receiving our protocols for a few weeks, their pain is significantly reduced. Afterward, when they do have a recurrence of pain, they can come back and receive a few visits of laser therapy to get that pain back under control. One particular patient who was referred to LTI's founding clinic because of her CRPS diagnoses had been dealing with the condition for a couple of years, which had started after she had iced her leg a lot following a surgery. She felt like the ice had contributed to the hypersensitivity that she was experiencing —hypersensitivity that was so severe that no one could even breathe on her leg without causing her terrible discomfort. Due to this hypersensitivity, she could not wear pants because the clothes would initiate too much pain. Nor could she tolerate air movement on the leg, so wearing shorts was also problematic. She was in miserable pain continuously. Fortunately, we were able to work with her. Within just a few weeks of treating her, she felt amazing! After nearly every treatment on the area, the intensity of her leg pain reduced and became less sensitive. Once she had improved, we completed her treatment and were able to graduate her from care (which is the goal we set for all our patients). A couple of months later, she fell on an icy sidewalk and suffered a recurrence of pain in a different spot on the same leg. Fortunately, because she came back to see us quickly after the episode, we were able to have it resolved within three or four visits. Timing is another key factor of CRPS: The longer you have CRPS, the harder it is to fix. So, if you think you might be suffering from this condition, do not wait to address it!

If you are struggling with this right now or you are not convinced you have an accurate diagnosis for your pain, we strongly encourage you to find an LTI clinic near you!