Saturday, February 24, 2018

Nutrition and Movement for People with CRPS


When I see a patient with a presumptive diagnosis of Complex Regional Pain Syndrome, the very first thing I emphasize to them is “mobilization.” Regardless of how long they have been afflicted with the disorder, it is imperative that they keep the affected joint(s) moving. For example, it is common to find frozen shoulders in patients with upper extremity/brachial plexus CRPS. We then have to treat two problems, the second one being a consequence of the first.

To this end, it is equally important to find the right physical or occupational therapist to treat these patients. Also, the timeframe in which the treatment is initiated is important.

Simple mobilization must be initiated immediately. However, all too often, individuals are referred to physical therapy prematurely. If some attempt is not made to control the underlying problem, physical/occupational therapy will often cause more harm than the benefits it provides. Conversely, the use of physical therapy after the initiation of treatment to the underlying cause can and should be extremely beneficial.

It is really important for the referring physician to screen the physical or occupational therapist. Physician input is essential simply because overuse or overstretching of an affected limb by an overzealous physical or occupational therapist can cause irreversible harm both physically and psychologically.

On a separate note, Hippocrates, the father of medicine, said, “Let food be thy medicine and medicine be thy food.” Sometimes we tend to forget the importance of diet and nutrition in the treatment of CRPS and, for that matter, any chronic pain. I begin much of my treatment by recommending to my patients that they avoid aspartame, additives like MSG and nitrates, sugar, fructose, and simple carbohydrates, caffeine, yeast in gluten, dairy, and nightshades (tomatoes, potatoes, and eggplant). All these foods tend to have inflammatory components. This is certainly the last thing that we would need to be giving our patients that have an inflammatory disease.

Over the last two years, we have urged all our patients with CRPS to go gluten-free. Gluten sensitivity is actually an autoimmune disease that creates inflammation throughout the body. It can have wide-ranging effects in all organ systems including the brain, heart, joints, digestive tracts, and more. A paper in the New England Journal of Medicine listed 55 “diseases” that were directly related to the ingestion of gluten. Most notable among these was fibromyalgia, the symptoms of which parallel Complex Regional Pain Syndrome. Other noteworthy diseases include osteoporosis, inflammatory bowel diseases, and multiple sclerosis and almost all other autoimmune diseases.

Finally, it is important to have an adequate ingestion of B vitamins. Low levels of folic acid, B12, thiamin, riboflavin, and B6 can have an adverse effect on chronic pain and mood while excessive levels of B6 have been shown to create pain. The stress brought to bear by the constant pain of chronic disease causes B vitamins to be depleted quickly. In addition to the recommendation of multivitamins, we recommend that each of our patients take omega-3 fish oils, probiotics, vitamin D, digestive enzymes, and magnesium and calcium on a daily basis. Many individuals with chronic pain eat poorly or inappropriately. They do not get the basic necessities of supplementation in their diet and so this list provides patients with supplements that will facilitate better health and immune system support for their chronic inflammatory disease (CRPS) and many other chronic diseases as well.

Learn more about CRPS with these 1-hour CME activities which have been designed for all clinicians who treat pain:

Philip Getson, DO, is a primary care physician in practice for 39 years and an assistant professor of medicine in neurology at Drexel University College of Medicine in Philadelphia, Pennsylvania. He is a member of the scientific advisory committee of the Reflex Sympathetic Dystrophy Association of America and one of their designated speakers. He has contributed to the national protocols for ketamine infusion therapy for complex regional pain syndrome (CRPS) and has lectured on the subject of CRPS nationally and internationally. He is a board-certified thermographer and vice president of the American Academy of Thermology.

8 responses

  1. Jennifer
    February 14, 2016 at 7:04 am

    Great article & helpful for sufferers like me. #crpsawareness

  2. Harriet Rose
    February 19, 2016 at 9:03 am

    We live in Little River South Carolina
    Our son moved back home with us because of his condition
    He was diagnosed with RSD/CRPS in 2004
    Until the last 2 years it has gradually gotten harder to handle
    He had to finally give up his job this past September
    Our problem is we seem to not be able to find physicians , neurologists, PT or OP for him to see and get the kinds of treatment he needs
    Can you help us?
    Do you know of anyone that understands and does treat his condition in our area
    Thank you so much for your help
    Harriet Rose

    • The Academy
      February 20, 2016 at 9:10 am

      hi – Thanks for writing! We recommend you contact RSDSA for CRPS – and they’ll be able to best help you find someone near you. Wishing you all the best –

    • March 6, 2016 at 9:46 am

      check Robert Schwartz, MD in Greenville, SC
      Best of health, Jim Broatch, RSDSA

    • Lisa
      February 11, 2017 at 10:46 pm

      Harriet, a pain management doctor might be able to direct you to someone. Pain management can help treat him. You just need to find one who is familiar with this disease. Physical therapist can also help as well as joining forums, many are more n Facebook, reading about the disease the get a better understanding of it helps as well. There are also many good websites that have valuable information on CRPS. I would also try the Mayo Clinic. They may be able to help you.

  3. Allyson
    March 6, 2016 at 11:00 am

    My son completed pain rehab at Cleveland Clinic. They emphasized hydration too. This, in combination with everything else they taught him, really helped.

  4. Tanya Mitschke
    March 15, 2016 at 9:45 pm

    I was diagnosed in October 2005 with RSD/ CRPS. My pain management Doctor told me that I needed to ” use it or lose it”. I learned to walk through the pain when I wanted to give up! I am happy to say that I no longer use any prescription medications and I find that proper nutrition is very important to keep the pain level manageable on a daily basis.
    I had success with hyperbaric oxygen treatments and many alternative therapies that I continue to use including pain products and supplements from Plexus. Nerve and Ease along with Probio5, BioCleanse and Plexus Slim. I share these products with others like myself and have improved my quality of life!
    This blog is the only one that I have read that I agree with. Many are still using prescription meds that ruin quality of life!

  5. Rev.Elena Daniel R.N.
    February 17, 2017 at 11:03 am

    Wow,alot of recommendations here…however as both a medical professional, and a person living with CRPS for the past 18 years, I would like to share my thoughts.First,I whole heartedly agree with “move it,or lose it”.I have never stopped moving my left arm and hand (my affected area) as much as I can,which is why I believe I do not have a withered,blackened,extremity,as some persons long affected with CRPS.I would however suggest that to keep moving(if you have an upper extremity affected)in addition to OT try something enjoyable and productive…my favorite activities are making jewelry and learning to play some stringed instruments such as a strumstick(only 3 strings,easy to learn).
    I also agree with Dr.Getson in regard to improving diet,but turning gluten free,no sweetners,giving up all caffeine…etc..I think is draconian,especially if the patient lives with other family members who either can’t,or won’t adopt the same sweeping changes.I do however agree that if you can afford them,taking some vitamins and supplements may help(I do).
    I also agree with other people who posted here in regard to trying alternative medicine therapies if you can afford them,especially acupuncture (I had a lot of success with this early on,but despite the success comp would not pay for the entire course of treatment).Finally,on any treatment you choose remember YMMV.CRPS affected people are all individuals….one size does not fit all.Even though you are in pain,you must be pro-active in your treatment plan.If your doctor’s plan isn’t working for you,let her know! Read all you can about CRPS,ask questions,join a patient organization.Pain is not a curse,or a punishment for being a ” bad”person,or a weak person.
    Best of luck to all my CRPS sisters and brother’s.

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