Download Complex Regional Pain Syndrome - Tiffany Steele`s E

Objectives
 Define CRPS
 Types of CRPS
 Symptoms associated with CRPS
 Role of Physical Therapy
 PT Intervention
 Other treatments options for pain management
 Conclusion
What is CRPS ?
 Complex Regional Pain Syndrome is a chronic pain
disorder. CRPS generally involves a dysfunctional
response of the nervous system and may develop
after a traumatic injury or a period of immobilization.
 CRPS is divided into two categories: Type I (formerly
known as Reflex Sympathetic Dystrophy) and Type II
(formerly known as Causalgia).
Two Types of CRPS:
 CRPS I: Used to be known as reflex sympathetic
dystrophy. Is frequently triggered by tissue injury;
the term describes all patients with the above
symptoms but with no underlying nerve injury.
 CRPS II: Used to be known as causalgia. Patients
experience the same symptoms but their cases are
clearly associated with a nerve injury.
CRPS Diagram
Other names associated
with CRPS:
 Reflex Sympathetic Dystrophy (previous name for
CRPS)
 Reflex Neurovascular Dystrophy
 Amplified Musculoskeletal Pain
Symptoms of CRPS:
CRPS most often affects one of the extremities (arms,
legs, hands, or feet) and is also often accompanied by:
 Constant Pain
 Burning or stinging pain
 Increased skin sensitivity: pain caused by things that
do not usually cause pain, such as clothing, wind,
cold or a light touch to the skin
 Changes in skin temperature: warmer or cooler
compared to the opposite extremity
Symptoms of CRPS:
 Trophic Symptoms
 Changes in skin color: often blotchy, purple, pale, or red
 Changes in skin texture: shiny and thin, and sometimes
excessively sweaty
 Changes in nail and hair growth patterns
 Thinning of the bones
 Swelling and stiffness in affected joints
 Motor disability, with decreased ability to move the
affected body part
Other Symptoms:
 Tremors
 Depression or anxiety
 Sleep problems
Physical Therapy:
 Early physical therapy is essential to avoid atrophy
and contractures of the affected limb
 PT/ OT have been shown to reduce pain and motor
impairment, improve function and coordination
ability of the limb
 CRPS treatment strategy is usually multi-disciplinary,
with the use of different types of medications
combined with specific physical therapies.
PT Intervention:
 Physical therapy plays an important role in overcoming
kinesiophobia and facilitating active movement.
 Aggressive mobilizations and strengthening programs
should be avoided as they may contribute to the
development and maintenance of kinesiophobia.
 The interaction between pain severity, pain related fear
and kinesiophobia is critical for understanding the
complexity of persons with chronic pain syndromes.
 There is even evidence that pain related fear can be more
disabling than pain itself.
PT Intervention:
 Physical therapy should include gentle range of motion
exercises within patients’ tolerance levels.
 Gradually increasing range of motion, strength and
flexibility are important parameters to eventually improve
or restore functionality.
 Frequent desensitization exercises.
 Aquatic physical therapy may be useful to stimulate
weight bearing for patients with lower extremity CRPS.
 Posture correction may be necessary.
PT Intervention:
 Stretching
 Strengthening ex: mat exercises such as Feldenkrais techniques
 Weight Bearing
 Desensitization exercises ex: rub skin with different materials
 Aquatic Therapy
 TENS
 Contrast Bath
 Pacing
 Relaxation techniques
Other Treatments:
 Pharmacologic therapy
 Sympathetic nerve block
 Spinal cord stimulation
 Sympathectomy
 Intrathecal drug pump
 Psychological therapy ex: pain coping skills and
stress management
Conclusion:
 The overall role of the therapist during rehabilitation
of CRPS is to guide the patient through a program
designed to minimize pain and edema while
maximizing functional use of the extremity. As CRPS
varies greatly in severity and duration, it is very
important for the therapist to demonstrate
enthusiasm, support and encouragement of the
patient during the treatment process.
Questions
References:

http://www.stoppain.org/pain_medicine/content/chronicpain/crps.asp

http://www.rsds.org/pdf/ptotbrochure_604.pdf

http://www.rsdfoundation.org/en/en_clinical_practice_guidelines.html#Treatment

http://www.bethesdaphysiocare.com/professionals/pdf/jbmt_crps2_domm04.pdf

http://www.rsds.org/3/clinical_guidelines/TXguidelines_interdisciplinary_care.pdf

http://www.rsds.org/pdfsall/AMP_RNDparentHandout.pdf

http://www.medicalnewstoday.com/articles/184338.php

http://www.ninds.nih.gov/disorders/reflex_sympathetic_dystrophy/detail_reflex_sy
mpathetic_dystrophy.htm