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:
- An In-depth Look at CRPS: From Diagnosis to Treatment as Illustrated by Case Histories
- A Comprehensive Overview of Complex Regional Pain Syndrome
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.