Is there a CRPS treatment?
Is there a treatment for CRPS (RSD)?
Complex regional pain syndrome (CRPS) aka RSD, reflex sympathetic dystrophy is one of the most challenging chronic pain conditions to experience as a patient and for many doctors the “protocol” is to refer to a pain management doctor almost immediately. The good news is that this doesn’t have to be the case all the time.
The intense debilitating pain from CRPS/RSD can be life altering and the lack of answers from even the top “experts” is unconceivable. CRPS is characterized by limb-confined sensory, autonomic, motor, skin and bone symptoms, but the most consistent symptom is extreme pain.
Getting Past the Diagnosis
Rather than tell you how to get a CRPS diagnosis, let’s talk about some of the interesting factors that make CRPS a complicated condition and why alternative or functional medicine is really the only option left for many patients.
One interesting fact found in the research, is that CRPS is associated with migraines, osteoporosis and asthma. What this means is that although these are different diagnosis, they possibly share the same etiology or in other words, the chemistry that has gone wrong inside the body is similar in some way. Examining these types of predisposing factors can lead to improvements in CRPS. Asthma and migraines are correlated with high inflammatory markers like leukotrienes and also food sensitivities. Both of those can be addressed and should be addressed in the CRPS patient.
Another factor to note is that CRPS occurs in women more often than men by a 3-4:1 ratio. This means that it is gender related. The biggest and most obvious difference between men and women is the hormonal differences, namely high levels of estrogen that is found in women vs. men. Too much estrogen is pro-inflammatory and can lead to increased inflammation and mast cell activation. Mast cells are inflammatory cells of the immune system that help you to recover from injury and fight infection. When they are overabundant, then they create long-lasting pain. Thus, both lowering estrogen and balancing the immune system should considered in CRPS treatments.
While CRPS is debilitating, 85% of patients will have substantial pain reduction within the first 1-2 years after onset. This may be the most promising information as it shows that the body can naturally recover from CRPS on its own in the vast majority of cases. These statistics are specifically for people undergoing conventional medical care.
Pain and Nociceptors
Nociceptors are nerve endings or sensory receptors that are located throughout the body. They are responsible for giving feedback to the brain about the local experience in your hand or foot that you are having. CRPS is diagnosed by having more pain than you theoretically should. Pain without an equal experience of trauma or pain that lasts for longer than should be expected.
In our body, every time these nociceptors “activate” (depolarize) they create a pain signal. At first in most CRPS cases, it is an acute injury that stimulates the nociceptors, but after time, the original tissue damage or injury likely is not contributing to the chronicity of the pain.
I believe that most of this is due to stimulation of nociceptors from other chemicals. In this article I won’t go over each contributor to nociceptor stimulation in detail, but I do want to mention my top 5 chemicals in the body that depolarize nociceptors. I also suggest that these should be our focus as we move towards better patient care.
- Histamine – food allergies or environmental allergies must be considered. Given the number of environmental toxins we encounter each day, vitamins like B6, B9 and B12 are regularly depleted and the longer our histamine remains high, the less we are able to quench it.
- Leukotrienes – these chemicals are highly associated with asthma and CRPS. NSAIDs like ibuprofen or aspirin promote additional leukotrienes and the pain spiral can go downhill quickly
- Kinins – these chemicals can create additional blood flow in the injured area and possibly correlate with increased temperatures and swelling.
- Serotonin – Serotonin is known as the “feel-good” neurotransmitter. Certain estrogen changes correlate with serotonin levels. Excess estrogen can cause increased levels of serotonin that can depolarize nociceptors
- Proteoglycans – Research tells us that certain proteoglycans sensitize nociceptor nerve endings. Proteoglycans are a type of GAG (glucosaminoglycan) that are found in high levels in tissue/joints that are undergoing repair from damage.
I would suggest from clinical experience that histamine and leukotrienes are the most common problems that need to be tackled in CRPS cases. NSAIDs used as pain killers need to be limited and avoided if possible for CRPS patients as they lead to even more leukotrienes, which can be more than 100 times more inflammatory than the chemicals that NSAIDs stop (prostaglandins). While the above 5 chemicals are “normal” and even beneficial in an acute injury, in chronic pain like CRPS or fibromyalgia, these chemicals need to be properly controlled in order to recover from pain.
A comprehensive article on inflammation and CRPS is difficult to write. There are a lot of possibilities that can contribute to each individual case. Additional considerations can be thinks like metabolism and mitochondrial energy support, liver detoxification to reduce cytokines, gut healing protocols to reduce LPS and immune system re-balancing to stabilize mast cells.
The key point I wanted to make in this article is that if you haven’t considered other contributing factors that could be contributing to your CRPS, then you really haven’t started a comprehensive approach to this difficult condition.
Yes, physical therapy for CRPS is an important starting point and sometimes pain managment can provide temporary relief, but unfortunately the current state of CRPS treatment is sub-par and needs more in-depth analysis of both the internal chemistry and the external environmental stressors that perpetuate the pain.
We have to look past the limb in pain to get to the root cause.
**Please call the office to talk with Dr. Anderson regarding your individual case.