Exercise Superior To Treat And Manage RSD/CRPS Patients’ Pain Long Term
RSD/CRPS is a very painful condition and initially patients may not full understand many of the unique physical changes that may occur to their body.
Exercise is important in treatment
of RSD/CRPS but only if done briefly, intermittently, with a lot of rest in-between. In activity and exercise both can cause pain, so it is best to alternate the two to counteract the complication of RSD/CRPS.
Clinical experience teaches that early recognition and treatment are necessary to avoid permanent disability and that the effectiveness of treatment is limited once the patient has reached the chronic fibrotic stage. Certainly, the incidence and severity of RSD/CRPS can be greatly reduced by initiating prophylactic measures in situations that are known to be triggers (eg, hemiplegic stroke, Colles fracture). These measures include immediate and aggressive mobilization of the involved extremity with passive and then active range-of-motion exercises. Similarly, in patients with established RSD/CRPS, physical and occupational therapy are key components of any therapeutic regimen.
The World Health Organization
(WHO) based guideline for the treatment of RSD/CRPS, analgesic ladder, is advised, with the exception of strong opioids. For neuropathic pain anticonvulsants and antidepressants may be considered with free-radical scavengers advised for inﬂammatory symptoms. To promote peripheral blood ﬂow, vasodilatory medication or percutaneous sympathetic blockades may be indicated. Decreasing impairments in function, activity limitations, and participation restrictions, utilization of standardized physiotherapy and occupational therapy are recommended.
Although treatment according to this guideline may be effective in some cases, a large group of CRPS patients do not sufﬁciently respond to the treatment and may progress to chronic CRPS with associated disabilities and restrictions in daily life. Despite a variety of interventional drug treatments and guidelines, there is a need for a more comprehensive and possibly more effective treatment of patients with RSD/CRPS.
Pain exposure physical therapy
) has been shown to be a promising comprehensive treatment for patients with longstanding RSD/CRPS. PEPT consists of a progressive-loading exercise program and management of pain-avoidance behavior without the use of speciﬁc RSD/CRPS medication or analgesics. It is based on the assumption that behavioral and psychological factors can exacerbate pain and dysfunction and might help to maintain the condition in some patients. Therefore, effective management of RSD/CRPS requires that these psychosocial and behavioral aspects be addressed as part of an integrated treatment approach. PEPT can be seen as a countermeasure of disuse and pain-avoidance behavior. PEPT focuses on psychological and behavioral factors that maintain pain avoidance and disuse and is based on the assumption that a progressive-loading exercise program will reduce peripheral and central sensitization and may restore the local autonomic deregulation and cortical representation in CRPS.
Living without adaptations or living independently from
caregivers, returning to work and employment, and restarting
domestic life, self-care, mobility, hobbies, and sports were the
main treatment goals. Pain relief itself was not a primary treatment goal, and patients were informed that an increase in pain
or after the exercises and activities might occur. Patients
were reassured that an increase in pain was not a sign of injury or tissue damage.
In this respect, all conscious and unconscious signs of catastrophizing and kinesiophobia behavior were speciﬁed and talked through with the patient and his or her partner. If, despite explanation, doubt remained about the treatment content or when patients were not motivated to act upon instructions of the therapists, the treatment was stopped.
The treatment consisted of progressive-loading exercises and desensitization beyond the patients’ pain limits. To decrease the enhanced skin sensitivity for touch and pressure, desensitization was carried out using self-massage and forced use of the affected arm or leg in daily activities. Homework exercises are a crucial aspect of PEPT. The treatment sessions mainly consisted of rehearsing and testing the homework exercises. The progressive-loading exercises were tailored and focused on speciﬁc body functions using standard techniques in regular physical therapy, including passive and active exercises to mobilize joints and muscle stretching. During progressive loading, the physical therapists acted mainly as instructors, rewarding functional progression and providing schedules for exercises and activities at home. Complaining about pain was discouraged, and it was no longer a subject of debate or a reason to reduce the treatment intensity.
A 3-week exercise program, with emphasis on behavioral and psychological management, in 69 children and adolescents with RSD/CRPS, utilizing this program, found a 51% improvement in pain severity and 62% improvement in physical functioning. In summary, the data indicates that exercise programs despite pain, with a focus on normal activity and participation, may be effective. The added value of PEPT is that pain relief and complete remission of RSD/ CRPS symptoms can be reached without speciﬁc RSD/CRPS medication and/or other invasive treatments.
About Belt Law Firm, P.C.
Belt Law Firm, P.C., is an Alabama law firm with extensive national experience in representing RSD/CRPS afflicted persons and handling RSD/CRPS cases with a focus on regional litigation in Alabama, Tennessee, Georgia, Florida, Arkansas, Mississippi, Texas, New Mexico, Colorado and Delaware. To learn more, call the firm toll-free at 205-933-1500 or use its online form.