Chronic Pain – Case Study
In this case study, a 23-year-old male developed Chronic Regional Pain Syndrome (CRPS) after an accident at work. (it can be called Complex regional Pain Syndrome as well.)
It started as a relatively simple strain of numerous tendons in the hand. As is typical with manual workers it is hard for them to take time off to rest the injury. Whilst most issues recover given time, some can develop into a chronic pain syndrome. This is a complex condition which presents in multiple ways. It can be a straight pain in the hand but can involve the whole limb. It can also present with many other often bizarre symptoms like pins and needles, numbness, burning, sweating, blotchiness, redness, hot/cold or crawling skin.
The symptoms this particular patient had were a lot of sharp and achy pain. So much so that to even make a full fist or fully extend his fingers was too much.
The patient’s hand was hypersensitive to the point where he could not stand even clothes touching his skin. Further, the hand was swollen and often changed to a blue/purple colour and was very sweaty compared to his other hand.
CRPS can be described as the nervous system gone completely haywire, producing all sorts of signs an symptoms because the nerves are no longer reacting or behaving normally. The BMJ describes it as ‘Complex regional pain syndrome (CRPS) is characterised by constant regional neuropathic pain that does not follow the usual distribution.‘
More details of Chronic Regional Pain Syndrome are available here.
This complex condition is clearly difficult, requires a number of different approaches and can take a while to settle. However, without treatment, they can last years. The sooner treatment starts the quicker it is and the better the result. The research backs this up. The Chartered Society of Physiotherapy says ‘that prompt diagnosis and early treatment are needed to avoid secondary physical problems associated with disuse of the limb, and the possible psychological effects of living with undiagnosed chronic pain.’
Treatment is usually multidisciplinary but with Physiotherapy being at the front line. The national guidelines from the royal college of Physicians are here.
Physiotherapy treatment for this patient included using mirror therapy (where we use mirrors to “trick” the brain into allowing the hand to move more normally), kinesiology taping (which can be used to combat both swelling and hypersensitivity) as well as gentle exercises and manual massage and therapy to try and normalise movement and sensation. It is important to treat the whole of the nervous system including the neck and back. This is because the nervous system is continuous where everything is attached to everything else. Thus treating one area can affect another, particularly in CRPS.
The process has to be regulated by how the symptoms react and it is a delicate process which involves much input from the patient as well as patience.
Over 4 -6 weeks the swelling and movement began to return to normal and the sensitivity reduced. Once this happens we could then work on building up strength. using normal movements you almost soothe the nervous system into realising that its wild reactions to simple things are not warranted and gradually it calms down, allowing you to progressively challenge these reactions. A delicate line to tread.
I am pleased to say he made a full recovery over 3 months and he was back at work as a manual labourer after around 2.
If you have suffered from this condition and would like help to try and improve your symptoms please contact reception to book an appointment.