What is Complex Regional Pain Syndrome?

By: Dr. Adriana Martí

www.martipsychologicalservices.com

If that is the question that brought you here, then you are in the right place. My guess is that

you are probably reading this blog because you either suffer from Complex Regional Pain

Syndrome (CRPS), have a family member who has been diagnosed with this painful condition,

or maybe you are just curious. This blog will explore the nature of CRPS, it will review a patient

story whose identity has been concealed for confidentiality purposes, and it will discuss some

scientifically validated tools for managing and treating this chronic pain condition. Without

further ado, let’s dive into the world of CRPS together and learn what this condition is all about.

CRPS is a chronic pain condition that is considered debilitating for many patients as it causes

severe and persistent pain in a specific region of the body. Usually, the pain is disproportionate

to the injury, and it begins after a trauma to a part of the body, such as a surgery, sprain, or a

fracture. Scientists have classified two main types of CRPS: CRPS Type I, which is often produced

by an injury or trauma, and CRPS Type II, which is associated with a specific nerve injury.

Regarding the quality of the pain, some patients describe it as burning, stabbing, or aching, and

it may be accompanied by other symptoms, such as swelling, changes in skin color or

temperature, and decreased range of motion. Moreover, since CRPS is considered a

neurological condition, it can spread to other places in the body beyond the original injury. For

instance, if the injury happened in the right big toe, the pain might spread to the rest of the

right toes, the whole right foot, and even to the right ankle. This condition does not

discriminate as it can affect people of all ages, genders, and cultural backgrounds. Also, since

we all have different predispositions and genetics, the severity of CRPS symptoms can vary from

person to person, which is why it’s crucial that the treatment uses a whole person approach

that is tailored to the individual by a group of professionals who are trained in the treatment of

CRPS.

To understand what CRPS looks like for someone suffering from it, let’s review the story of

Luke, whose demographics and history has been changed to protect his privacy. Luke is a 42

years old physical education teacher who sprained his ankle one day playing softball. At first, he

rested for a couple of days and was surprised when the injury would not heal like the previous

times he had sprained his ankle but he did not think much of it. Nonetheless, the pain kept on

intensifying, and he also started experiencing some additional symptoms that he had never

experienced before, “It felt like my ankle was on fire, like if someone had put it on the grill, and

I could not even wear my sock.” After meeting with many specialists for a period of six months,

Luke was diagnosed with CRPS.

Now that we have discussed the physical symptoms of CRPS, let’s talk about the emotional and

psychological impact that this condition has on a person’s well-being. When a person starts

suffering from CRPS, it’s easy to focus on the physical symptoms and ignore the effect it has on

the rest of their life. The reality, though, is that due to the chronic nature of this condition, it

tends to have a significant negative impact on multiple components of a person’s life.

Specifically, many patients dealing with CRPS report symptoms such as fear of the pain,

frustration, poor sleep, and depressed mood. They also have a propensity to isolate from the

people and the things they enjoy because the pain is often so debilitating that it becomes

difficult to participate in previously enjoyable activities, such as playing basketball or going for a

walk in the park. Overall, if left untreated, this condition can affect many areas of a person’s

life, leading to a decreased quality of life and low self-esteem.

Since we have covered the basics of CRPS and the areas it tends to affect, let’s now discuss the

various treatments that are currently available for this condition. First, it’s important to state

that a multidisciplinary approach is needed for the optimal management of CRPS. This means

that the treatment team needs to be composed of a group of clinicians who have specialized

training in this condition, come from diverse clinical backgrounds, and work in collaboration

with each other for optimal results. For instance, a typical core treatment team for CRPS may

include a pain-trained physician, a pain psychologist, a physical therapist, a clinical pharmacist,

and an occupational therapist. Moreover, the focus of treatment is on rehabilitation, increasing

the patient’s functionality, and improving their overall quality of life which consequently may

have an impact on the pain symptoms.

When it comes to specific treatments, it’s crucial to also highlight that they need to be

individualized, as they will vary from person to person. One of the first-line treatments for CRPS

is the use of medications, such as pain relievers or neuropathic pain medications. For some

patients, these types of medications can help alleviate symptoms and provide significant relief.

In addition to medications, pain-trained physicians may recommend interventional procedures

such as nerve blocks to manage CRPS-related pain. While these procedures can be effective for

some patients, they may also carry risks and require careful consideration by the healthcare

team. That’s why before starting any treatment protocol, it’s important for the patient to

undergo an in-depth assessment with trained clinical professionals to determine the treatment

modalities that would work best for them.

Given that the psychological and emotional impact of CRPS cannot be underestimated, the pain

psychology treatment aspect is another crucial component for optimal management. Since this

condition can be very debilitating and isolating in nature, it often leads to a range of emotional

and psychological challenges, such as hopelessness, poor sleep, anxiety, and feelings of

withdrawal. Consequently, pain psychologists play a key role in supporting individuals suffering

with CRPS by helping them develop effective coping strategies to deal with the psychological

sequalae of CRPS. When working with a pain psychologist, treatment may involve the use of

techniques such as cognitive-behavioral therapy (CBT) to reframe negative thoughts and

behaviors related to pain, as well as relaxation techniques to manage stress and improve

overall well-being. Group counseling can also be incorporated, as it provides support and

validation while fostering a sense of shared understanding among individuals living with this

misunderstood and often invisible condition. Lifestyle changes are another strategy employed

by pain psychologists to help individuals with CRPS. For example, helping patients adopt an

anti-inflammatory diet can support the body’s natural healing processes and improve the

management of this condition. Incorporating restorative sleep is another crucial lifestyle

adjustment, as it reduces the psychological stress associated with CRPS while assisting the body

in the overall healing process.

Physical therapy is another indispensable component of the treatment plan for individuals with

CRPS. The primary goal of working with a physical therapist trained in treating CRPS is to

improve range of motion, regain physical function, and reduce the risk of further

deconditioning. Based on the individual needs, physical therapists may guide patients through

activities such as stretching, desensitization, graded motor imagery, as well as exercises that

improve balance and coordination. Helping patients use the affected limb is especially

empowering, as disuse can lead to further impairment and disability. Physical therapists may

also use modalities like heat, cold, or electrical stimulation to manage pain and promote

rehabilitation. It cannot be stressed enough that it is crucial that the physical therapist has

specialized training in treating CRPS, as misguided physical therapy approaches can contribute

to the worsening of this condition.

Remember Luke? Let’s go back to his story to illustrate how the whole person approach

described above was used in his rehabilitation process. Looking back to the beginning of his

injury, Luke remembers how CRPS took a toll not only on his physical health but also on his

emotional well-being, “I was not able to teach anymore, and I did not even want to be with my

wife or kids. Life was not the same and I did not feel motivated.” That’s when Luke’s primary

care physician referred him to work with a group of clinicians trained in the treatment of

chronic pain who recommended physical therapy, nerve blocks, and pain psychology. Luke

recalls that’s when he began to regain control over his life, “I thought that they had sent me to

see the shrink because they thought I was crazy, but she taught me how to have a positive

mindset and how to get back to doing the things that I enjoyed.” After working with his team of

clinicians, Luke was able to get back to work and be the husband and father that he wanted to

be.

Hopefully, by now, you have a better understanding of Complex Regional Pain Syndrome (CRPS)

and how excruciating it can be to live with this condition. Nonetheless, with the right

combination of medical interventions, physical therapy, and psychological support, it is possible

to adequately manage the condition and improve one’s quality of life. Luke’s story illustrated

the courage it takes to live with CRPS and how by working closely with a group of healthcare

providers, individuals with CRPS can collaborate with a treatment team to develop a

personalized treatment plan that addresses their unique needs and symptoms. While the

journey with CRPS may be challenging, it’s important to remember that there is hope. With the

right support and resources just like the ones Luke had, a person dealing with CRPS can learn to

adapt and take a more active approach, even in the face of this chronic and complex condition.