Brain-Based Approach For Complex Regional Pain Syndrome (CRPS)

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By: Dr. John Conde DC, DACNB Special to the Boca and Delray newspapers

Complex regional pain syndrome (CRPS), formerly known as reflex sympathetic dystrophy syndrome (RSDS), is a condition of uncertain etiology that produces chronic pain. It is characterized by severe pain and sensitivity, swelling, and changes in the skin. In some individuals, muscle atrophy and bone loss is seen. Precipitating factors include previous injury or surgery however this is very often not the case. A high correlation is seen with individuals with previous peripheral nerve injury, hemiplegia, and with smokers

The cause of CRPS is unknown, however the physiological dysfunction is better understood.  Neurological inflammation is typically extensive within the nerve tissue locally and at the level of the spinal cord. The inflammation irritates and triggers the pain nerves called nociceptors to fire more repeatedly.  In fact, the nociceptors become so efficient at transmitting pain that the system becomes self-sustaining and no longer requires a damaging stimulus to the tissue. This process is called sensitization and is exemplified by an increase in the number of connections branching off the nerve cell and an increase in the speed of transmission of nerve impulses. The pain transmission can becomes so extreme that the brain actually changes and adapts to this environment and further facilitates the pain cycle. In essence, the brain undergoes maladaptive plasticity which means that it rearranges itself for a disadvantageous purpose

Treatment is complex and multifactorial as pharmaceutical intervention with medication is not effective for CRPS. The goal of treatment is the following; reduce inflammation, stop the pain cycle locally and at the level of the spinal cord, re-establish proper brain integrity and re-mapping of brain, and institute proper autonomic control of vascularity (blood vessel diameter).  The contemporary approach involves functional neurological rehabilitation to address CRPS which utilizes aspects of many disciplines including occupational therapy, physical therapy, speech therapy, cognitive exercises, and vestibular rehabilitation.

Functional neurological rehabilitation is centered upon receptor based techniques. In essence this means that the human senses such as touch, taste, smell, hearing, and seeing are utilized in the rehabilitation strategies. These modalities electrically excite very specific areas of brain utilizing the sensory systems. When these receptors in the sensory system are activated with repetition, intensity, and specificity they can actually re-wire your brain. Low-tech and high-tech rehabilitation is utilized stemming from oculomotor (eye tracking) exercises on a touch-screen monitor to the Dynavision D2 which is a computer driven 64 LED light board that has been utilized on professional athletes in the NFL and NASCAR. Diet and supplementation should also be looked at and addressed. Low glycemic and anti-inflammatory approaches have shown promise.

Dr. John Conde is a Board Certified Chiropractic Neurologist, one of only one thousand in the country. He holds diplomate status through the American Chiropractic Neurology Board. He provides specialized care for difficult cases of back neck pain, numbness-tingling, vertigo-dizziness balance disorders, fibromyalgia, migraines, AD/HD, autism, and dyslexia. His office is located at the Atlantic Grove in Delray Beach, FL and can be reached at 561-330-6096, drconde@thecondecenter.com, and at www.thecondecenter.com