Complex Regional Pain Syndrome From a Runners Position
Complex regional pain syndrome or, CRPS in short, is not only severely painful, it is a condition that can disable the patient. Unfortunately, runners are more susceptible to experiencing it due to the amount of stress they put on their muscles and bones. However, the situation gets worse when these runners are not aware of the severity of the condition.
You cannot really tell if a minor injury could eventually turn into a complex regional pain syndrome if not taken care of in time. In fact, its injuries like strain, sprain, or scrape that could lead to CRPS. The most common symptom of this condition is that it’s severely painful.
There are more than eighty thousand reports of people diagnosed with this chronic regional pain syndrome every year only in the U.S. This leads to a more careful treatment plan and approach to ensure the disability doesn’t become permanent. Therefore, a multi-disciplinary approach should be undertaken. This approach consists of seeking help from psychologists, physicians, and even physical therapists.
Overview of Complex Regional Pain Syndrome
CRPS is a painful condition that a person usually experiences after an injury. The condition often affects a single limb – a foot, hand, leg, or arm. The condition is chronic and can last more than six months. While there could be several causes that may lead to complex regional pain syndrome, it is often associated with the malfunction or damage caused to the central or peripheral nervous systems.
The blame goes to the damage caused to the central nervous system mainly because it is composed of both the brain and the spinal cord. On the other hand, it is associated with the peripheral nervous system as its role is to send signals to the body – especially the spinal cord, from the brain.
There are various factors that characterize the occurrence of CRPS including change in the skin color, excessive or prolonged pain, swelling, and/or different temperatures of the affected area.
There are two different types of CRPS: CRPS-I and CRPS-II. If the patient does not have any confirmation regarding the nerve injury, the condition is often classified in the first category. This was previously called the reflex sympathetic dystrophy syndrome. On the other hand, CRPS-II is characterized for patients with confirmed, associated nerve injury.
Ironically, the categorization of the chronic regional pain syndrome is often overlooked because in both cases, the treatment is same. However, as far as the symptoms are concerned, the duration and symptoms may greatly vary in each case.
While the condition could have a long-lasting, disabling impact, some cases are only mild and may not need treatment to heal. In other severe cases comprising of complications, patients may go through long-term disability and take time to recover even after treatment. You will read more about the symptoms later in this article.
Who is Susceptible to Getting CRPS?
Unfortunately, women are more susceptible to getting this disabling disease as compared to men. Moreover, while there are not age limitations for people getting affected by this injury, the peak age is 40 years. The reported cases of experiencing CRPS in children under the age of 10 is very low.
Common Symptoms of CRPS
The most common symptom is experiencing severe pain in the affected area for prolonged period. The sensation of this pain is often associated with that of ‘pins and needles’ or ‘burning.’ In short, it feels like the affected limb is constantly squeezed between two fingers.
There is no limit as to how much the pain could spread across the limb. In worst cases, it could affect the entire leg or arm even if the injury was associated with a toe or finger. Sometimes, the pain could even have an impact on the opposite extremity.
CRPS, also known as reflex sympathetic dystrophy syndrome, or RSD, has a number of other symptoms that could alert the patient about what is coming their way. These include the change in the skin color of the affected area, skin temperature, and even swelling.
This is a result of the damaged nerve and the abnormal microcirculation of both temperature and blood flow. This is one of the major reasons why the affected area may seem slightly cooler or warmer as compared to the other limb. The patient may notice the skin of the affected limb becoming blotchy or changing color to pale, purple-blue, or even red.
Some of the most common symptoms of RSD or CRPS are:
- Change in the texture of the skin of the affected area; the skin may appear thinner and shinier
- Change in the color of the skin of the affected area; the skin could turn pale, purple-blue, or even red
- Experiencing stiffness in the joints of the affected area
- Changes in the texture of hair and nails
- Affected growth pattern of the hair
- Pain while moving the coordinating muscles; affected area may even have an impact on the coordinating muscles and other body parts affecting its functionality
- Experiencing abnormal movements of the limb; including dystonia (abnormal postures), jerking of the limb, and tremors.
- Increased sensitivity and pain in the affected area
- Joint and tissue swelling
- Increase in sweat
Complex regional pain syndrome may show further symptoms including low levels of libido, difficulty in sleeping, loss of memory, depression, and increased agitation and irritability.
How to Diagnose Complex Regional Pain Syndrome
Unfortunately, there are no tests to confirm the condition of CRPS. However, it is ideal to see a neurologist for the diagnosis since a specialist is familiar with the symptoms of the syndrome. The physician will ask the patients about their medical history and symptoms to confirm that they are suffering from this injury. It is essential to carry out a detailed and informed examination to confirm CRPS since there are other conditions related to the nervous system that can show similar symptoms. In some cases, the condition reverses and begins to improve on its own with time. If you see a doctor during this stage, the diagnosis could become ever more challenging.
Carrying out a detailed examination may also help with ruling out other conditions with similar symptoms – such as Lyme disease, arthritis, clotted vein, general muscle disease, and even fiber polyneuropathies. This is done carefully since each condition requires a different treatment. The most obvious and distinguishing factor that keeps chronic regional pain syndrome separate from the rest is that it is associated with an injury. This is also a major reason why runners may experience it more commonly than others. People who experience the symptoms of CRPS after an injury should mention this to the doctor during the physical examination. This single factor can help with diagnosis even better.
A detailed examination of the affected area is carried out by a neurologist. The specialist carefully assesses the patient to ensure proper treatment is advised. In addition to a physical examination, some neurologists may even suggest getting triple-phase bone scans or magnetic resonance imaging tests for further confirmation before having the final diagnosis. If the results show excessive bone resorption, it may certainly indicate CRPS. This is a process during which bone cells break down and let the calcium mix into the blood. This result could also indicate towards other severe medical conditions.
What about the Prognosis?
The overall result of complex regional pain syndrome is extremely variable. People of a younger age have a higher probability of better results. Some older patients may also attain good results. However, some people would continue to experience disability and severe pain regardless of the treatment.
It is suggested to have a proactive approach in terms of the diagnosis and treatment. The quicker you take an action in fixing the condition, the better chances you have in limiting the disorder from the damage. Since the causes of the CRPS condition are still unclear, the progression, as well as the significance of early treatment, cannot be further unfolded.
What to Expect from a Physical Therapist
While it is highly recommended that you consult a neurologist for proper diagnosis and treatment, you can also seek help from a physical therapist. They can play an important role in treating the condition without major side effects. People may experience different sets of symptoms for CRPS. A physical therapist can help you determine a treatment plan to address your specific symptoms. They may use a variable approach to help you identify the symptoms you are experiencing. Generally, the treatment plan will vary according to the severity and duration of your condition. Your therapist may include the following in your treatment plan:
The first thing that comes to mind about a therapist is the ‘movement therapy.’ As mentioned earlier, the condition may have a significant impact on the physical functions and may lead to disability. Movement therapy is a great way to keep up with the physical mobilization of the affected areas. A therapist may suggest beginning a movement therapy soon after a final diagnosis of CRPS is carried out. This is done so that the body does not have to experience severe disability by maintaining its functions and preventing the stiffness of the joints and muscles. During the therapy, your therapist may ask you to perform various active and passive movements. In fact, they may suggest a combination of movements based on your specific symptoms and the severity of your condition.
GMI (Graded Motor Imagery)
The next treatment option your therapist may suggest you is the Graded Motor Imagery. It is important to understand that our brain is the main network operating our body and its functions. Even the smallest movements are depending on the computations carried out by our brain. This is why therapists often use this method to ensure if your physical function is on point.
Keeping your specific symptoms in mind, a physical therapist may suggest carrying out GMI on you. This is basically a rehabilitation process to treat disorders like chronic regional pain syndrome. GMI has shown great results in treating patients with CRPS. It has also been considered in terms of reducing movement problems and easing the pain. The rehabilitation procedure exercises the brain in various monitored and measured steps to boost its functionality. These steps include the discrimination therapy of left and right, exercises for motor imagery, as well as mirror box therapy.
Mirror Box Therapy
The third step in the cycle, this therapy is actually a part of the Graded Motor Imagery. In this therapy, the therapist will require an individual to use the unaffected part of the body in the mirror. The reflection would make the person see the affected part moving without a problem. This creates a psychological impact on the patient.
When the exercise is carried out in front of the mirror, the impact on the patient would be as if they are using the affected limb. With the right mindset and constant effort, this therapy can play a major role in encouraging the patient to bring their disabled/affected limb back in action.
However, it’s important to note that therapists may not suggest a high level of exercise of physical activities to CRPS patients. Moreover, the treatment of CRPS does not recommend thermo-electric modalities including ultrasounds, electrical stimulation, heat, and ice. CRPS treated with these methods can be extremely harmful. Thus, it’s important to ask questions from your therapists before starting any treatment to ensure you are dealing with the right doctor and receiving the right treatment for your condition.
How to Find the Right Therapist
Since the wrong treatment can make the condition worse, it is important to find the right therapist. Consider the following points before finding one:
- Make sure the therapist has a board certification. It’s always better to consult a therapist who possesses fellowship or residency in physical therapy. Don’t take a risk with any general therapist you know. Instead, conduct your own research and find a therapist with advanced knowledge, skills, and experience.
- Look for a therapist who holds high credibility and good reputation in terms of providing treatment for CRPS or similar complex conditions.
Besides this, follow these rules to find the right person for treating your condition:
- A known therapist is always going to be better than an unknown one. While it’s highly recommended that you conduct ample research, don’t forget to ask for recommendations from your friends and family. Your dear ones will guide you according to their first-hand experience.
- When seeking for an appointment, do not hesitate to ask the assistant about the experience and skills of the therapist with your particular condition.
- Be very clear about your symptoms when speaking to your therapist for the first time. Go prepared and don’t hesitate in asking as many questions as you want until you are totally satisfied. Get into details when it comes to describing your symptoms. The more you open up about your condition to the doctor, the better treatment they will be able to advise you.
Preparing for Your Appointment
Whether you have an appointment with your doctor/surgeon or a psychotherapist/physical therapist, you should prepare yourself to get the best medical care you deserve. First and foremost, grab a pen and paper and write down everything you have been experiencing – the list of signs and symptoms related to your pain as well as your running habits. In addition, don’t forget to mention the location and the severity of the pain you are experiencing.
In case you feel sensitivity or stiffness in the affected area, make sure you put it down on the paper. Other than that, it’s a great idea if you also write down all the questions you have for your doctor before you visit. Here are some important ideas that will come in handy when it is time to meet your doctor:
- What are the main causes of the signs and symptoms that I am facing due to CPRS?
- How can you be so sure that it’s actually CPRS?
- Are there any additional tests I should undergo before you make your final diagnosis?
- Is my condition chronic or temporary?
- What options do I have with regards to my treatment? And what primary treatment methods would you suggest me and why?
- What are the best alternative treatment methods to the primary ones you are recommending?
- I have other health conditions too (if there are any, do not hesitate in sharing it with your doctor). How should I manage the treatment of CRPS without disturbing the other medical condition?
- Are there alternatives to the medicines you are suggesting me?
These are just a few example questions that you can add to your list. If you have more, feel free to add and make sure you take very informed decisions about your treatment.
Other Methods of Treating CRPS
Though you have learned about the significance of physical and rehabilitation therapy, there are other treatment methods to get rid of complex regional pain syndrome too. Some of them are as follows:
Since the condition is not only painful but also disabling, it can have a long-lasting psychological impact on the experiencing individual. It is very common for a CRPS patient to suffer anxiety, depression, and traumatic disorder. These psychological symptoms can further elevate the severity of the condition. In case the pain is too severe, it can also make physical therapy and rehabilitation more challenging.
Therefore, it’s essential to treat these problems and help them recover from the condition before further damage is caused. Psychotherapy helps keep depression, anxiety, and other similar disorders at bay while the treatment is being carried out.
Different types of medications can be advised by your doctor based on your specific symptoms and severity of the condition. Fortunately, a number of medications have proved to be helpful and effective in the treatment of complex regional pain syndrome. However, if you are looking for approved list of medication by the U.S. Food and Drug Administration, you will be a little disappointed to know there’s nothing specific out there for CRPS. In fact, even a doctor cannot suggest a drug or a combination of medicines be effective for all. Since the condition varies from person to person, the treatment should be done accordingly. Some of the most common drugs that have proved to help with CRPS treatment include:
- Bisphosphonates, such as intravenous pamidronate or high dose alendronate
- Corticosteroids – this also helps with the treatment of edema, swelling, and inflammation
- Anti-inflammatory non-steroidal drugs to help ease the pain – these include medicines like naproxen, ibuprofen, and aspirin
- Drugs that are mainly designed to help with conditions like depression and seizures – such medicines may show great results with treating neuropathic pain.
- Local topical anesthetic creams to ease the pain
- Opioids such as Vicodin, fentanyl, hydrocodone, morphine, and oxycontin. Since these drugs can be addictive, they are only advised in certain conditions and are closely monitored by the doctor.
It is not recommended to use any of these medicines without approval from the doctor. These medicines may have several side effects and need to be closely monitored when patients are using them under the treatment. Some side effects include dizziness, drowsiness, impaired memory, and increased heartbeat.
Sympathetic Nerve Block
Another treatment your doctor may suggest you is sympathetic nerve block. This involves injecting an anesthetic along the spinal cord to instantly block the sympathetic nerve activity. This is mainly done to improve the blood flow in the body. Patients report ease in pain after going through this procedure. However, there is no evidence of having long-term relief with this procedure.
The surgical treatment for CRPS is debatable to date. Some surgeons support surgical sympathectomy for its beneficial outcomes while others still believe that destroying certain nerves to relieve pain could actually make the condition worse. In most cases, the surgical method is only advised to patients who achieve favorable outcomes using the sympathetic nerve blocks. In both cases, it is essential that you take a very informed decision before undertaking a treatment as serious as this.
Spinal Cord Stimulation
This procedure places stimulating electrodes near the spine through a needle. When the electrodes reach the affected area, it creates a tingling sensation. This procedure does not give immediate results. In fact, it is observed on the basis of multiple procedures to find out if the tingling sensation is helping with the pain.
Some patients may require minor surgery for implanting different electrodes, batteries, and stimulators under the skin. A controller can be used for adjusting the stimulator and for turning it on and off accordingly. In addition to the list mentioned above, there are various other therapies used alternatively to treat CPRS and likewise painful conditions. Some other options include acupuncture, behavior modification, relaxation techniques (such as Guided Motion Therapy, progressive muscle relaxation, and biofeedback), as well as chiropractic treatment.
However, it is never advised that these therapies should be used without consulting your doctor. Make sure your doctor is totally aware of what you are experiencing to offer you the best treatment method he can.
Is It Possible to Prevent This Condition?
Scientists are still carrying out research to find out the main mechanism behind the CPRS symptoms. Since the mechanism is still unclear, it cannot be easily predicted if the injury or CPRS condition can be prevented through a set of rules.
However, early treatment is a good way to manage the condition before it does further damage. The key here is to observe the signs and symptoms and do not delay your visit to a doctor. When signs and symptoms are detected earlier, it can easily help the medical providers to recommend you the best treatment.
As far as diagnosis is concerned, your physical therapist can also offer you effective treatment options. You can consult your physical therapy to identify and develop specific strategies to understand and address your CRPS symptoms.
The following steps will help the patients with CRPS with an early management:
- Even before the diagnosis is carried out, observe your symptoms and judge if these are related to CRPS. The best way to do this is by learning about the complex regional pain syndrome as much as you can. Just like with any other condition, educating yourself is the best way to find a treatment that saves you from further damage.
- Learning more about the syndrome can help you maintain better health while you are experiencing it. Understanding the mechanism behind CRPS can help you with daily management before you see your doctor and are ready for medical treatment.
- Continue to move regardless of pain. Yes, this is easier said than done because people who experience CRPS often go through a lot of pain. Sometimes, the pain is so unbearable that moving the limb seems like an impossible task. But this is where a little effort will save you from long-term disability. Keep moving, even if it is painful when you do. While it’s highly recommended that you see a doctor as soon as you can, moving your limb is the only way you can save yourself from disability. However, do not go overboard with the movement. You do not have to stress the muscle. You just have to keep using the limb to prevent contractures and other conditions like dystonia.
- Relaxation exercises might help too. Your physical therapist may also suggest you various relaxation techniques to help ease the pain and treat the condition. Since patients experience daily painful episodes when suffering from CRPS, relaxation techniques can be a savior.
- Try to stay away from anything that stresses you out – even if that means taking a break from work if you can. Stress related to work, regular commuting in the loud noises of the city, and living situations that are not up to the mark are some major factors that would add up to your stress. You can always consult your therapist and ask for helpful ways to ease your nervous system.
It can be extremely challenging to live with a painful, chronic condition as serious as this. With complex regional pain syndrome, the pain could get worse if not treated in time. People who have no idea about this condition may not even believe when you explain the severity of the pain you are experiencing. However, it is crucial to have a stress-free environment around you. To make this possible, you must share information about CRPS with your loved ones.
The following are some suggestions that will help you cope up with the condition without compromising on your mental or physical health.
- As difficult as it may get, try and maintain your daily routine as much as you can. Keeping up with your daily activities in a normal way will help you divert your mind from pain and other problems related to your condition.
- Don’t stress yourself or your limb. Carrying out your normal activities does not mean over-burdening yourself. You definitely need more rest than usual. Therefore, make sure you are getting enough.
- Don’t disconnect from your loved ones. In times of distress, your friends and family can help you cope up with this injury. They are the support you need in this difficult time.
- Do whatever helps you distract your mind. If there are any activities or hobbies you enjoy, make sure you continue to pursue them.
There are always ways to tress-pass obstacles. So don’t hesitate in asking your doctor how to adapt a stress-free lifestyle while you are under the prescribed treatment. Also, inquire if you can resume your running routine even during the treatment. If your doctor disagrees, this means that it is time to take a break from running.
Always remember this: your physical health affects your mental health. Keeping calm will help you fight frustration, depression, anger, and other symptoms.
Use the information shared here in your best interest and make sure you follow the steps in finding the best doctor and/or physical therapist for you to put you back on your foot and running again.
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