Complex Region Pain Syndrome: How Can It Be Treated?

  • Labels like complex regional pain syndrome (CRPS) are not helpful without some thought about how to treat the condition. Previously, when the focus was on the sympathetic nervous system and the label was reflex sympathetic dystrophy (RSD), people with RSD/CRPS were lined up for sympathetic nerve blocks-stellate ganglion blocks. After 20 or 30 some odd blocks, some people still had severe pain. Instead of being confused by these "non-responders", clinicians now know that the sympathetic nervous system is not the primary culprit in CRPS. Higher up in the nervous system is the ever-controlling brain. Lately, the brain is gaining a lot more attention since the discovery of some fancy imaging studies that can actually "see" the brain in action. The brain just might be the link to many types of pain syndromes, not just CRPS.

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    With the brain as a primary treatment target, research conducted in the past ten years has illuminated possible solutions for CRPS. One solution tries to reset the brain. Wouldn't it be nice to have a brain "refresh" button? You know that button on your computer that you can push if it gets stuck. Well, sometimes the brain gets stuck singing a painful tune and it needs to be refreshed into a different tune. This concept is the essence for "graded motor imagery" as coined by scientists in Australia who have had some success in treating CRPS by refreshing and reconstructing the brain. The sequence and execution of the brain reconstruction is critical.


    First, the treatment starts with "Laterality Reconstruction" which restores the accuracy and speed of identifying the left and right sides of the body. The ability to tell the difference between left and right seems like an elementary skill; however, this skill is often lost in those with CRPS. Maybe this form of "neglect" is the brain's way of protecting the limb. No one is sure why the laterality skill deteriorates. Nevertheless, the ability to accurately distinguish the left and right side of the body is the first step for reconstructing the brain because the next step requires imagery-motor imagery.

    Essentially, this requires the patient to imagine movements and postures. Have you ever said to yourself, "It hurts just to think about moving"? Well, thinking about moving accesses critical pathways in the brain that precede the actual execution of the movement. Athletes use motor imagery to improve performance. In turn, CRPS patients can use it to associate movement as being a safe and non-threatening pathway in the brain, instead of a scary and dangerous trail that causes pain.


    The last step in the graded motor imagery treatment for CRPS is mirror therapy. The use of a mirror presents the reverse image of unaffected limb, thereby "tricking" the brain into thinking that the affected limb is O.K. This trick may be an old trick, but putting it into this sequence of graded exposure is novel and makes sense. Mirrors might not work if the brain cannot tell the difference between left and right. Mirrors might not work if a safe, non-threatening movement pathway has not been cleared of the painful detours. So, maybe this graded motor imagery is a "refresh button" for the brain. And pushing this button could be worth a try if you have chronic pain.


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    For more information about this research visit, Please share your experiences and thoughts in a comment below. Sharing creates solutions!


    See also:  CRPS: What Is It?

Published On: November 18, 2008