There are many treatments that are regularly used for patients diagnosed with Complex Regional Pain Syndrome. However there is no one specific treatment designed for CRPS at this moment, although there are trials going ahead around the world for a specific treatment. Unfortunately at this time, there is no actual cure. There are a number of CRPS treatments that are used to help patients manage the many signs and symptoms of CRPS.
However there is one thing that doctors are encouraged to do for patients diagnosed with CRPS, which was stated in the research study by Hsu, E.S. (2009) which is:
“… we need to start pain management immediately with the ambition to restore function in every probable case of CRPS. An interdisciplinary setting with comprehensive approach (pharmacologic, interventional, and psychological in conjunction with rehabilitation pathway) has been proposed as protocol in the practical management of CRPS.”
“… we need to start pain management immediately with the ambition to restore function in every probable case of CRPS. An interdisciplinary setting with comprehensive approach (pharmacologic, interventional, and psychological in conjunction with rehabilitation pathway) has been proposed as protocol in the practical management of CRPS.”
There is a great website resource called About My Pain which gives chronic pain and CRPS sufferers information about treatment including the Dorsal Root Ganglion (DRG) stimulation treatment for CRPS. Why not have a look at the website?
The CRPS treatments are split up into groups, as there are different areas that are used to try and restore the function and even the movement of the limb that has been affected, many of which will be mixed together to give you a full pain management regime. They are:
- Ice – Ice is not a form of treatment for CRPS, however we have included this section to make people aware that ice isn’t an appropriate form of CRPS pain management
- Nerve Blocks
- Non-invasive – Calmare Therapy
- Psychological Therapies
- Pain Management Programmes (PMPs)
- Treatments not typically used at first
- New Treatments Being Researched
- Alternative Therapies
PHYSIOTHERAPY as CRPS TREATMENT
The idea of physiotherapy and other methods is to try and relieve at least some of the signs and symptoms that are caused by the condition. This involves both Physiotherapy and Occupational Therapy. Physiotherapy in conjunction with Occupational Therapy (OT), especially in the early stages of the condition, plays an important role in functional restoration of the CRPS limb (Singh, M et al. 2015). It is also suggested by the professionals that physio is used together with other treatments given to patients with CRPS, such as medication, alternative treatments, implanted devices. (Daly, A.E. & Bialocerkowski, A.E. (2008))
- MOVEMENT of the limb affected by CRPS can try to be restored by using muscle strengthening exercises, gentle movement and some exercises for the whole of the body – learning to cope with the condition in your life (See the Burning Nights blog on COPING STRATEGIES). When you first go to physiotherapy do ask them if they have had any experience of people with CRPS as this will make a difference as to how they approach things with you.
- The Occupational Therapist (OT) could help give you tips and to learn different ways to do everyday things and activities – do this by pacing your daily activities over the whole day, so you do not become as tired.
- DESENSITISATION TECHNIQUES – most of you with CRPS who have been to physio’s around the country or in fact the world will have been told about desensitisation and how important it is. This is done by using different textures to gently rub at the beginning, on your CRPS affected limb. This could be using a tissue, feather, cotton etc. Then as you gradually are able to tolerate the textures try and rub slightly harder until you can tolerate the different textures and therefore stop causing you to feel any pain.
- EXERCISE – don’t try and do exercise without a physio or an OT because you will need to be shown which exercises are good for you and your affected limb but they can also offer support and encouragement.
- AQUA (WATER) THERAPY – If you are able to tolerate water then this is a good form of therapy so that you become weightless in the water thereby enabling you to do exercises that would ordinarily be difficult outside of the water. There is also the possibility of using a hydrotherapy pool where the water is a lot warmer than a usual pool and can help with the problem of being sensitive to temperature changes.
- TENS THERAPY – This is a small device with small stickable pads that you can use outside of your body to give you a form of stimulation to try and reduce the pain you are feeling. The idea is to cut through the pain signal from your brain to your limb affected by CRPS.
- PAIN EXPOSURE PHYSICAL THERAPY (PEPT) – PEPT is a patient-centred physical therapy, also know as the “Macedonian method”, which was developed by Ms. Shinka in 2003. It is based on the supposition that limited use or non-use of an extremity or limb, whether or not caused by fear of movement or pain, can lead to disease deterioration. PEPT is tailored towards improving activities in daily life, using progressive-loading exercises, desensitisation and ‘self-forced’ use, in which patients have to encourage themselves to use their affected extremity, both during treatment exercises and in daily activities, without the use of medication. (Raymakers, L. 2015) A recent study undertaken by Barnhoorn, K.J. et al. (2015) found that the patients having PEPT showed a greater improvement in AROM but more research is needed.
- Kinesio Taping – Kinesio Taping method has been looked at for CRPS. The RSDSA have produced a Q & A about Kinesio Taping method for CRPS by Andrea Wolkenberg, PT, MA, CKTI.
- MIRROR THERAPY – Mirror Therapy or Mirror Visual Feedback therapy is consider by some researchers such as Breivik, H. et al. (2013) a good tool to use in conjunction with other therapies for CRPS sufferers. Brevik, H. et al. (2013) stated that:
It is not the mirror, it is more the context in which it is used, that has effect. Focus on information and motivation, dosing, and compliance is essential.
See Anandkumar, S. & Manivasagm, M. (2014)
A review has just taken place (Smart, K.M. et al 2016) on physiotherapy for pain and disability for adult patients with CRPS and in this review the authors found that mirror therapy and Graded Motor Imagery or GMI gave meaningful improvements in pain and function for those people suffering with CRPS I.
Some physiotherapists in the past have used ice as a therapy for CRPS. However, there is very important thing to point out, that doctors, specialists and healthcare professionals recommend that you NEVER PUT ICE nor use any cold or hot/cold contrast therapy on the limb that has been affected by CRPS. It can cause symptoms to come on faster and can even cause frostbite if the ice is held on too long – See Nishikawa, M. et al (2008). In the case study by Nishikawa, M. et al (2008) a patient, despite repeated cautions against cold-induced injury, continued all-day cooling of the CRPS arm. She was later admitted to hospital once again with extensive skin necrosis on the left arm and a contracted left elbow joint. The areas of skin necrosis exactly matched the sites where she had applied ice packs.
According to the RSDGuide (2013) they state that:
“Application of any type of a cold compress to an area that is affected with CRPS reduces blood flow to the area. It also damages the myelin sheath surrounding the nerve tissue and constricts blood vessels. CRPS makes it difficult for the blood vessels and myelin sheath to recover, possibly causing nerve and blood vessel damage and further aggravating the condition.”
In an case study article by Hooshmand, H. et al. (2004), they stated that the reason why cryotherapy should NOT be used is that:
“…use of cryotherapy can cause permanent somatosensory and thermosensory (sympathetic) nerve damages with contrasting complications of focal somatic myelinated nerve fibers damage and focal pain, versus C-thermoreceptor nerves (CTN) damage causing neuropathic regional pain and inflammation (skin ulcers). Long-term exposure and extreme hypothermia can cause permanent nerve damages.”
Hooshmand, H. et al.(2004) also stated that:
“..prolonged and repetitive ice application can cause damage to the myelinated motor and sensory nerves. The myelin sheath is rich in lipids. Ice application results in solidification and hardening of the myelin lipid, similar to application of ice on melting butter. This can lead to an arrest of motor and sensory nerve conduction. Even brief ice application, lasting no more than 20 minutes, can cause transient paralysis of the motor and sensory nerve fibers, lasting as long as one year (1).”
MEDICATIONS for CRPS
There is no specific medicine for CRPS so they are taken from other conditions such as epileptic drugs, anti-depressants etc. This also includes opiates which are pain relieving medicines. Doctors will try different medicines that would suit the symptoms you have, as there is a large list of drugs that are available.
If you begin a new medication and you become dizzy or disorientated or even nauseous and vomiting please TELL your doctor immediately as they may have to alter the dose or change the drug altogether. The longer you are on a certain regime of medicines then you may become tolerant and/or dependent. If you feel that you are becoming either tolerant or dependent do TELL your doctor or specialist so they can help you straight away. DO NOT simply stop taking the drugs as you may suffer a serious problem. Get medical advice so they can give you a regime of coming down off the medicines. The usual medicines used to treat CRPS below are by no means an exhaustive list, but examples of the drugs are:
- NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS) – these are used for the moderate pain that may be present. These include ibuprofen, aspirin
- EPILEPTIC MEDICINES – Gabapentin, Pregabalin / Lyrica
- ANTI-DEPRESSANTS – Amitriptyline, Nortriptyline, Duloxetine
- CORTICOSTEROIDS – This is for when you have swelling in your affected limb. These drugs include Prednisolone (Atalay, N.S. et al. 2014) and (Bianchi, C. et al. 2006) and (Barbalinardo, S. et al. (2015)
- OPIATES – Morphine Sulphate / Morphine / Sevredol, Oramorph, Oxycodone, Oxynorm
- PAIN PATCHES – Fentanyl, Lidocaine, Clonidine
- CREAM/OINTMENT – DMSO 50%, Lidocaine also comes as a cream/ointment as well as a patch as it acts like an anaesthetic
- NASAL CALCITONIN – This would be used for very deep pain in the bone
- N-methyl-D-aspartate (NMDA) – These are drugs such as Ketamine OR IV Magnesium – See Below and Connolly, S. et al. (2015) and Fischer, S.G.L. et al. (2013)
- CAPSAICIN – (chilli base) This can be a topical cream, infusion, nasal spray, patch (eg. Qutenza 8%)
See Perez, R.S. et al (2010)
In a recent study by Hanlan, A.K. et al. (2014) Lidocaine ointment was seen as:
“…. a non-invasive, inexpensive and effective adjunct treatment in the management of pain in a spinal cord injured patient presenting with early CRPS. “
By applying the Lidocaine Ointment, according to the same study by Hanlan, A.K. et al (2014) they said:
“The clinically important effect of topical lidocaine for reducing severe allodynia allowed the patient to participate in rehabilitation strategies to further manage the debilitating consequences of her CRPS, including decreased range of motion (ROM) and function. The immediate pain relief from topical lidocaine allowed the patient to tolerate physical therapy sessions directed at her CRPS.”
NERVE BLOCKS / INJECTIONS in TREATMENT of CRPS
These are injections put into the affected limb or extremity and are done usually by a pain specialist. They are done if other treatments such as NSAIDs or physiotherapy have been unsuccessful. Some people with Complex Regional Pain Syndrome (CRPS) or chronic pain say that these blocks can give them some temporary relief from their pain and other symptoms they may have connected to CRPS or other chronic pain conditions.
They include –
- REGIONAL / PERIPHERAL NERVE BLOCKS See Dadure, C. et al. (2005)
- STELLATE GANGLION BLOCKS – See Wei, K. et al. (2014)
- SPINAL/LUMBAR BLOCKS or sometimes called SYMPATHETIC NERVE / GANGLION BLOCKS – they are injections containing some form of anaesthetic drug e.g. Clonidine or Baclofen and are inserted immediately next to the patients’ spine. They usually give a good improvement to the flow of blood.
- BOTULINUM TOXIN INJECTIONS (BOTOX)
- EPIDURALS – This tends to be done at the early onset of the condition as studies have shown both injection form and also a temporary or semi-permanent epidural where you remain in hospital and you would be numb from the waist downwards.
See Forouzanfar, T. et al. (2002)
This area would include things such as:
- SPINAL CORD STIMULATOR (SCS) – this is a very expensive treatment used for CRPS and many PCT’s / hospitals are reluctant to do this. The cost is in the region of £15,000 and so you would have a trial stimulator put in for a few days, weeks or a few months and then if the trial is successful for you in reducing your pain and symptoms then they will implant the full SCS. Before you are considered for an SCS you have to go through a full psychological assessment. Electrodes are put on the spinal cord and a battery pack is inserted at the front of your body under your skin in the abdomen region. You are given a ‘wand’ to place on the outside where the battery pack is and you can control the on/off and volume of the stimulation up and down. There are now however different types of SCS including a 10 kHz High Frequency SCS – See Russo, M & Van Buyten, J-P. (2015) Usually the SCS is seen and implanted as a last resort treatment due to various implications including the cost and invasiveness of the treatment. However research studies such as the 2012 Poree, L. et al. study say that:
“Newer information regarding safety, cost, and efficacy leads us to believe that SCS for the treatment of CRPS should be implemented earlier in a treatment algorithm using a more comprehensive approach.”
- INTRATHECAL DRUG PUMPS – These are placed in the spine and gives medication through the spinal fluid. The drugs tend to be opiates or anaesthetic drugs like baclofen. Unfortunately there is no actual research to say that there this works for CRPS patients.
- PATIENT CONTROLLED ANALGESIA (PCA) – This is very similar to the Intrathecal Drug Pump but the drugs involved are either delivered continuously or you are able to push a button thereby giving yourself more medication when you require it. Many people have PCS’s in hospital usually after an operation to give them pain relief.
- DORSAL ROOT GANGLION STIMULATION (DRG) – Dorsal Root Ganglion is a small bundle of nerves that are involved in sending pain messages to the brain. They control when sensations can enter your spinal cord and you will find there is a DRG in every section of bone in your spine. DRG stimulation uses implanted equipment under your skin in your spine to send mild electrical impulses to the area of the DRG in your spine. Deer, T.R. et al. (2015), Van Buyten, J.-P. et al. (2015) and van Bussel, C et al. (2014) and Apiliogullari, S et al. (2015) and Oxford University Hospitals DRG leaflet (2015). Learn more about the Dorsal Root Ganglion Stimulation treatment for CRPS from our DRG stimulation treatment blog. Also check out the About My Pain website for DRG stimulation treatment for CRPS.
This sort of stimulation does not have to be just given in the region of the spinal cord. There is usually no surgery involved in this sort of treatment but it may involve many sessions following the initial one.
Many chronic pain patients who may have been affected by Post Stroke Pain or may have even had a stroke and are struggling with walking. It can be given along any of your pain pathways which for example include the exterior of the brain membranes (the medical terminology for this is ‘motor cortex stimulation with dural electrodes’), the areas of your brain that control pain (the medical terminology is ‘deep brain stimulation’) and near to nerves that have been injured (the medical terminology is ‘peripheral nerve stimulators’). New research has comprised of using magnetic currents that are directed to the exterior part of the brain – the current name for this treatment is ‘rTMS or Transcranial Magnetic Stimulation’.
In a 2013 randomized, multicenter, double-blind, crossover, sham-controlled trial done by Hosomi, K. et al (2013) they “aimed to assess the efficacy and safety of 10 daily rTMS in Neuropathic Pain patients.” In this trial they discovered that:
” The real rTMS, compared with the sham, showed significant short-term improvements in VAS and SF-MPQ scores without a carry-over effect. PGIC scores were significantly better in real rTMS compared with sham during the period with daily rTMS. There were no significant cumulative improvements in VAS, SF-MPQ, and BDI. No serious adverse events were observed. Our findings demonstrate that daily high-frequency rTMS of M1 is tolerable and transiently provides modest pain relief in NP patients.”
rTMS = Transcranial Magnetic Stimulation
VAS = Visual Analogue Scale
SF-MPQ = Short Form of the McGill Pain Questionnaire
PGIC = Patient Global Impression of Change scale
BDI = Beck Depression Inventory
CALMARE PAIN THERAPY TREATMENT (R) (also known as SCRAMBLER THERAPY) – Calmare Therapy is considered a non-invasive and non-pharmaceutical treatment used for chronic pain sufferers and since 2011 used for CRPS/RSD sufferers. According to Dr. M. Cooney , the Clinical Director and Calmare NJ Certified Provider he explained that it wasn’t an intentional focus on his part to treat CRPS/RSD sufferers, however he found that Calmare is very useful in treating several types of chronic pain including CRPS/RSD. One of his 1st CRPS/RSD patient was a lady called Amanda Davidson from Indiana, USA (YouTube video) Both Amanda and her mother were very involved in the CRPS/RSD community and she shared her very positive outcome with the support groups she was involved in. Patients go and have Calmare Pain Therapy treatment from as far away as Australia and South Africa.
Calmare Pain Therapy Treatment is considered a painless, drug-free device that blocks the pain message from the brain over a series of daily treatments. It uses several small electrodes, similar to an EKG (or ECG in UK), to transmit as pain-blocking message to the brain.
Calmare® device is a U.S. FDA 510(k)-cleared and European CE mark-certified pain therapy medical device for the non-invasive treatment of chronic neuropathic and oncologic pain. (Calmare Therapeutics)
They have achieved positive outcomes in 80% of cases, meaning that the pain has been significantly reduced to a 1-3 on the Universal Pain Scale or, often completely eliminated. This makes Calmare a very effective chronic pain treatment.
- Pain Free
- Drug Free
- No Side Effects
- FDA-Cleared 510 (k)-cleared and European CE mark-certified
- Q and A about Calmare Therapy also known as Scrambler Therapy
- Calmare Scrambler Therapy for Children and Teens
Most people who have been diagnosed with CRPS often have problems associated with the condition such as Post-Traumatic Stress Disorder (PTSD), anxiety, depression, general stress – all of these psychological aspects won’t help the pain from that you get from the condition.
You may find it hard to relax, unable to cope or find that you don’t get support from family and even friends. All of things are perfectly normal to feel if you have been diagnosed with CRPS and also for anyone with chronic pain. In fact in a majority of occasions it will intensify the pain feeling and it tends not to help the sufferer cope with everything associated with CRPS nor does it help people rehabilitate. So many treatments are often used for the psychological aspect of the condition these include:
- Cognitive Refocusing (Distraction techniques / Therapy)
- General Counselling i.e. talking through your problems and worries
- Group Therapy Programmes (Sometimes part of Pain Management Programmes – See below)
PAIN MANAGEMENT PROGRAMMES (PMP)
These are programmes where you will need to be referred to either by your Pain Specialist or GP.
They are usually in-house i.e. short or long stays in the Pain Clinic part of the hospital however there are now some found at GP’s surgeries. The groups that you will become part of don’t tend to be large instead they have around 6-8 people in similar situations like yourself. They teach you ways of coping with your CRPS or chronic pain, try and improve your quality of life and also learn techniques for better sleep. Various Healthcare Professionals will usually be involved during your stay including, Physiotherapists, Psychologists, Occupational Therapists and obviously Doctors / Pain Specialists. There are over 300 Pain Clinics around the UK but there are not as many PMP Centres.
Please ask your Pain Specialist or GP if they can refer to a PMP near your own home – it may help you deal with CRPS.
TREATMENTS NOT TYPICALLY USED FOR CRPS AT FIRST
There are many treatments that are fairly new but are not used very often due to funding issues, availability and other contributing factors. These are:
- HYPERBARIC OXYGEN THERAPY (HBOT) – This form of treatment is often used in patients who have MS. There are actually very few centres with HBOT in the UK. However there have been several studies done that discuss the use of HBOT with patients who have chronic pain including CRPS patients, but very few in the last few years. Unfortunately there is simply not enough research into the use of HBOT for CRPS patients and it is still unknown as to whether it would help with pain and oedema / swelling. You would lie down in the chamber which has pressurised air. The treatment would in effect give your body more oxygen i.e. in all your tissues and organs. You would be breathing 100% oxygen at a higher than normal atmospheric pressure, whereas the usual air we breathe everyday has around 21% oxygen. In the study by Kiralp, M.Z. et al. (2004) they found that:
“….significant decrease in the wrist circumference (due to decreased oedema) was observed between groups, between the end of treatment (after session 15) and day 45…”
- INTRAVENOUS IMMUNOGLOBULIN (IVIG) – This has recently been studied by the noted consultant and researcher Dr Andreas Goebel along with other professionals. His recent study 2014 – ‘Immunoglobulin G for the Treatment of Chronic Pain: Report of an Expert Workshop,’ Pain Medicine. The trial of only 13 patients who had been diagnosed with CRPS and had not responded to other treatment were involved in this study. The end result was that those who had been given the IVIG had found that there was a decrease in their pain scores. Also See Tamburin, S. et al. (2014) To find out the results from the much larger Low-Dose Immunoglobulin trial aka LIPS trial visit -> Low-dose intravenous immunoglobulin treatment for complex regional pain syndrome (LIPS): study protocol for a randomized controlled trial Unfortunately the research study into IVIG for long standing Complex Regional Pain Syndrome (CRPS) by Goebel, A. et al (2017) did fail and patients weren’t able to tell the difference between the placebo and the actual drug itself. See Goebel, A. et al (2017) for further info
- BISPHOSPHONATES – Bisphosphonates (BPs) are potent inhibitors of osteoclastic activity widely used for the management of osteoporosis and other metabolic bone diseases There have been a couple of trials of BPs such as the Neridronate in 2013 ( Gatti, D. et al 2013) and also a variety of BPs in 2015 ( Giusti, A. & Bianchi, G. 2015). It was found in a placebo controlled trial by Varenna, M. et al (2013) that aminobisphosphonate neridronate shows significant benefits in patients with CRPS. In this trial in CRPS, aminobisphosphonates seem to be most effective in high doses and in the trial, 2 100 mg doses of neridronate were given intravenously four times over 10 days, estimated to be equivalent to pamidronate at 90mg given four times over 4–10 days. The results were that ≥50% reduction of the pain VAS score was seen in 73% of patients in the neridronate group versus 32% in the placebo group.
- KETAMINE (oral or infusion)– In some patients ketamine has been used to treat CRPS pain where other treatments have not be successful. This drug is actually an anaesthetic and there have been studies where patients with CRPS were given ketamine in low doses intravenously for a few days. They then find that there is either an elimination of the pain or substantial reduction. However the specialists have not recommended ketamine for many people as the drug can induce what is known as Ketamine Bladder. This is where your bladder is totally affected by the drug and cause serious harm. According to Connolly, S. et al. (2015) it was found that:
“There is no high quality evidence available evaluating the efficacy of ketamine for CRPS and all manuscripts examined in this review were of moderate to low quality. Therefore, we conclude there is currently only weak evidence supporting the efficacy of ketamine for CRPS…”
If a patient with CRPS has their pain relieved by sympathetic nerve blocks, then specialists may consider a surgical sympathectomy, which is an operation to cut or remove some of the nerves.
This operation is very rarely used as there are specialists who believe the symptoms of CRPS may become worse in the patient.
According to Hooshmand, H. & Phillips, E. in their study article on CRPS and Sympathectomy they say that:
“Sympathectomy may provide temporary pain relief, but after a few weeks to months it loses its effect. Sympathectomy and the application of Chemical Sympathectomy (neurolytic agents e.g. phenol, alcohol, etc.) should be limited to patients with life expectancies measured in weeks or months – e.g., cancer patients. Chemical Sympathectomy (e.g., alcohol, phenol or hypertonic saline nerve blocks) aimed at destroying the nerves are apt to fail, to cause serious complications, and aggravation of the pain – by leaving a large scar behind. Complex Regional Pain Syndrome (CRPS) patients should not be exposed to aggravation of pain due to sympathectomy, chemical sympathectomy or radiofrequency sympathectomy.”
Within the same article their conclusions are that:
“Surgical procedures have no place in treatment of CRPS. Sympathectomy or removal of a part of the chain of sympathetic ganglia (on the side of the spine) has an extremely high rate of failure.”
NEW TREATMENTS BEING RESEARCHED
There are a number of treatments being trialed at the moment and you can find the latest research on our LATEST RESEARCH page. However the main new treatments that are being trialed at the moment include:
- CREATE-1 trial – This is trialing Oral Zoledronate and it is currently being trialed in USA, UK and Australia. Please visit our Latest Research page to find out which UK hospitals are involved in this trial. Zoledronate or Zoledronic Acid is from a group of medicines called bisphosphonates (pronounced bis-FOS-fo-nayts). Zoledronic acid inhibits the release of calcium from bones.
- STUDY CRPS-I – This is currently happening in Germany, USA and UK and has very strict criteria to join the trial including that it is only for CRPS-I. This trial is for Neridronic acid with placebo. In UK there are only 5 centres currently with this trial and they are Royal Devon and Exeter Hospital, London SE1 7EH, Chelsea and Westminster Hospital, Darlington DL3 6HX, Site GB104 – The Royal Victoria Infirmary and Cambridge NE1 4LP
- Zoledronic Acid or T-121 is currently under FDA Phase 3 clinical trials
- HYPERBARIC OXYGEN THERAPY or HBOT – We mentioned HBOT above, however up until 2016 there had been no proper information about HBOT for CRPS sufferers until the case report by Katznelson, R. et al. (2016). Hyperbaric oxygen therapy (HBOT) is a treatment that delivers 100% oxygen at increased atmospheric pressures.
Some people and professionals do not agree with the different typical treatments used for patients with CRPS and often try different alternative therapies to aid the symptoms of CRPS. Why not have a look at our Series of Guides to Alternative Therapies for CRPS blogs? The different alternative therapies for Complex Regional Pain Syndrome include:
- Acupuncture or Acupressure – Acupuncture is now also seen as safe and effective for children (Whiteman, H. 2015)
- Chiropractic treatments
- Orthotics (Podiatry) – This could help you if your CRPS is in your lower limbs and you are having trouble with mobility, problems with fitting in shoes etc.
- Relaxation techniques (See above Psychology)
- Yoga or Tai Chi (if you are able to get into the positions)
- Massage therapy – GENTLE of course!
- Breathing techniques – There are many deep breathing exercises that can help maybe not with everyday CRPS pain but could help with pain flare ups
- Mindfulness – this uses techniques from yoga, meditation and breathing. This is a good website to go to – BE MINDFUL
- Herbal remedies or Chinese Natural remedies
- Vitamins including antioxidants – See Latest Research links below ‘Vitamin D for the treatment of chronic painful conditions in adults’
- Diets specifically aimed at CRPS patients – It will vary and alter depending on each person but it would be considered nutritionally high reducing any inflammation or selling you may have as a result of CRPS. However you MUST talk to your GP or pain specialist BEFORE embarking on a new diet as it may have an effect on your medication. Drink plenty of water if you do decide to go on this sort of fresh produce diet.
There is no specific diet aimed solely for CRPS, however there are diets aimed at the anti-inflammatory properties in foods. This involves the 4 F’s which are
- Fresh Fruit – not canned
- Fresh vegetables – Olive oil is the best cooking oil
- Fish – baked or broiled. Use fresh lemon juice for flavor. Avoid the use of margarine
- Fowl – skinned. Not fried – baked, roasted or grilled
(Hooshmand, H MD.)
The diet that Hooshmand, H. MD. devised in conjunction with the Neurological Associates is not aimed at losing or gaining weight. However what the diet is for is to exclude those foods that are deemed harmful to your health and could aggravate chronic pain i.e., the Five C’s: cookies, cakes, chocolate, cocktails and candy. Instead this diet emphasises the intake of foods that help the inhibitory nerve cells that suppress the pain input (4 F’s: Fresh fruit, fresh vegetables, fish, and fowl.)
- Lean meats e.g. skinless chicken or turkey. Roast lamb or beef should be kept in moderation because of the high content of fat
- Low-fat dairy products
- Skimmed Milk
- Iced Tea
- Whole grains
- Fish e.g. crab, prawns, sardines or lobster as well as white wish such as cod or haddock but not in batter from the local chip shop!!
- Fresh and natural produce without preservatives or fillers e.g. different coloured bell peppers, chilli peppers, garlic, onions, avocados, tomatoes, fruit, spinach, sprouts, aubergines, squash, beetroots and broccoli
- Different types of nuts e.g. unsalted and raw
- Olive Oil
- By eating these food groups it is to aid and enhance your overall well-being.
Studies have shown that organic produce is good however this is not been authenticated
BEST METHODS OF COOKING – This includes roasting, grilling, baking or broiling. Try not to fry food and if you do use an oil spray which are now widely available in supermarkets.
HOWEVER – There are some foods that are not recommended to be eaten when living with chronic pain by Healthcare professionals. These would include the 5 C’s of cookies, cakes, chocolate, cocktails and candy:
- High sugar content food e.g. cakes, pies or ice-cream
- Sugar unless it is in the raw form
- Fizzy drinks e.g. Coca-Cola TM, 7-Up TM
- Coffee or strong tea
- Bleached flour products e.g. white pasta
- Processed food
- Fruit in tins that contain syrup if you have to eat tinned fruit get the fruit in natural juices
- Offal or internal organs e.g. liver, heart
So, as you can see there a number of CRPS treatments available to help you manage your Complex Regional Pain Syndrome signs and symptoms. However the CRPS treatments are treating the symptoms of CRPS rather than treating the actual condition as there is no one specific treatment for CRPS as of yet. There are drugs being trialed and researched at the moment to treat CRPS however until those drugs have been trialed by humans and they have been approved, complex regional pain syndrome sufferers have to use medication off licence.
- About My Pain website by Abbott – Available from: <http://aboutmypain.co.uk/?utm_source=BurningNightsCRPS&utm_medium=referral&utm_campaign=ReferralLink>
- Anandkumar, S. & Manivasagam, M. (2014) ‘Multimodal physical therapy management of a 48-year-old female with post stroke Complex Regional Pain Syndrome,’ Physiotherapy Theory Pract. 2014, Jan. Vol 30(1). pp 38-48. Available from: <http://www.ncbi.nlm.nih.gov/pubmed/23879307> doi: 10.3109/09593985.2013.814186
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Last Updated: 01/05/2018