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December 18, 2008

Complex Regional Pain Syndrome

Here's an interesting condition that I had never heard of before PT school. Complex regional pain syndrome (CRPS). It starts with an injury and evolves into excruciating pain beyond the proportion of the injury.

According to my Neuroscience text:
CRPS is a syndrome of pain, vascular changes, and atrophy. The term regional indicates that the signs and symptoms present in a regional distribution (upper limb or lower limb) rather than in a peripheral nerve or nerve root distribution. Typically the signs and symptoms are worst in the distal extremity, affecting the entire hand or foot. An aberrant response to trauma produces the syndrome. The trauma may be quite minor; for example, an ankle sprain that heals within a few days may precipitate the syndrome.

I found an article that describes an athletic child who developed the syndrome following an Achilles tendon sprain. Follow her journey from pain to diagnosis to treatment, which involves nerve blocking drugs and physical therapy. This includes seeing a clinical psychologist to help the patient cope with their debilitating pain. With a multidisciplinary approach, the patient's prognosis is 90% recovery with a 20 to 50% chance for relapse.

Unfortunately, massage is contraindicated to manage CRPS because the pain it too intense for the affected extremity to be touched. However, general massage may be beneficial as part of the patient's overall well-being. Recognizing the syndrome is crucial so as not to accidentally bump or brush the affected extremity. Doctors prescribe physical therapy for the syndrome, but honestly, at this point in my training, I don't know what PT can do for the patient. The article mentions electro-stimulation, I'm assuming in an attempt to help control pain (gate-control theory of pain management) and control edema.

tags: massage massagetherapy wellness massage therapy bodywork health

Posted by linda at December 18, 2008 8:23 AM