Can a New Treatment for CRPS Help Others in Pain?

Caroline J Davies

Finding normal or safe sensations, is key to a promising new treatment for people with Complex Regional Pain Syndrome (CRPS), and offers hope to everyone in pain

If you close your eyes, can you picture where your legs are or what position they are in? Can you feel what direction your knees are pointing to or how bent your ankles are? Can you feel your feet on the floor or the hardness or softness of it? Can you feel the softness of your socks or the pressure of your shoes around your feet?

These are the types of questions I might ask someone with Complex Regional Pain Syndrome (CRPS) while doing a session of Cognitive Multisensory Rehabilitation (CMR) or “Safe Sensations”, as one of my patients aptly named it. I first came across this approach when I worked at a NHS national specialist service for Complex Regional Pain Syndrome (CRPS) at the Royal United Hospital Foundation Trust, in Bath which runs a two-week residential programme. The goal of this innovative therapy is to help people with CRPS rediscover their normal arm or leg sensations or feelings which can restart the process of recovering from this condition.

What is CRPS?

CRPS affects peoples’ arms and legs, or parts of them, their elbows, hands, wrists, knees, feet or ankles. It is very difficult for them to feel any normal feelings in the affected part of their body, have a sense of where it is and even the shape of it feels distorted to them. More likely, they will feel that their hand, arm, foot or leg doesn’t even belong to them, referring to it in the third person and believing that if they could only get rid of it they would be OK again.

Unfortunately, a lack of normal sensations doesn’t mean this part of their body is numb to pain—quite the opposite—people with CRPS will have horrible burning or freezing types of pain and extreme sensitivities to normal sensations that we might hardly notice, like a breeze blowing over their skin or the feeling of clothing on their bodies. Many of these patients have to resort to wearing shorts or short-sleeve shirts throughout the year, and if their CRPS is in their foot or ankle they will struggle to wear regular shoes or even sometimes socks.

Along with this extreme pain and hypersensitivity, there are other distinctive signs to CRPS: the affected area of skin changes colour, often a worrying array of reds and purple splotches; there are nail and hair growth changes; alterations in sweating; and, if all of that isn’t bad enough, the fingers toes or arm and leg can stop moving normally or altogether. It can, from the outside, appear as if someone has had a stroke in that part of their body. Truly, this is an awful condition to have.

How does noticing these “normal” feelings help people start to reverse their CRPS?

Interestingly, when we don’t have any problems in our bodies, we don’t even really notice these normal feelings, they just are there in the background. We only notice how we feel in our bodies when someone asks a strange question like I did above, or when something goes wrong. Our brains actually anticipate and run a predicted set of expected everyday feelings for us, so right now my brain is running the expected feelings of sitting at work waiting for a patient while working on my laptop and yours will be running whatever version of reading or multitasking you are doing. This leave our brains more capacity to focus on what is new or different; this saves energy and also keeps us safe as we (our brains) are always anticipating what might happen next.

Therefore, although we have all of these amazing sensors all over our bodies to pick up every kind of feeling you could imagine, they aren’t really doing much other than keeping an eye out for something not matching the brain’s predicted programmes! It’s a bit like how we might keep an eye on our kids, dogs or older family members, we don’t watch their every move but we will immediately notice if they are suddenly quiet, get too near a road or tip over slightly as if they are going to fall.

So, noticing how your feet feel on the floor, where your hand is on the table, how cool that breeze is over your legs or what it feels like to put weight onto your foot will disrupt the business-as-usual automatic programming that our brains like to do. Although it will be the subject of another article, our brains can also get into the “Habit of Pain”: running a predicted programme of painful feelings to accompany certain activities or even every aspect of our lives. Perhaps the expected painful feelings are for bending over, sitting in a certain kind of chair, putting weight through your foot, or something in your hand. Of course, to start with, this pain can be useful to warn us, not to further damage ourselves in the days, weeks or month or two after we have sustained an injury, but after months and months or years and years, this Habit of Pain really gets old! Feeling your normal feelings will help to remind your brain that perhaps it is time to knock off that pain programme and run the normal feelings one again.

Wait a minute- our brains are responsible for our pain?

Our brains do, as it turns out, have the ultimate authority on whether we feel pain in our bodies. It is not automatic that when we are injured, we have pain; sometimes our brains decide pain is not useful or helpful in that moment. For example, you might be an emergency situation, an intense sport’s game or event you’re in, or a work situation that is all consuming, and pain in that moment, would interfere with you surviving or succeeding.

There might be some examples in your own life where you got hurt but didn’t have pain until later? Equally, what is less known, is that sometimes you can be in pain without any bodily damage at all. Instead, it might be caused by something or even someone you were scared of hurting you or stopping you achieve something, or a threatening thing happening elsewhere in your life; your brain still wants to get your attention about these threats. We might have passed through or ignored the uncomfortable feelings or emotions and all that the brain has left to warn us with is pain.

This all then leads us back to the question of how can feeling normal feelings help people with CRPS or other pain problems? Well, as the brain has the last say, presenting some new evidence of some normal everyday things happening in your arm, leg, or body even, may well be enough, over time, to get the brain to turn the pain down and resume normal services to that area.

What breakthroughs in pain treatments could also help people with CRPS?

There are some exciting new approaches to treating pain that could be helpful to people with CRPS. These include Pain Reprocessing Therapy (PRT), Emotional Awareness and Expression Therapy (EAET) and Scrambler Therapy. I will cover these further in future articles.

PRT and EAET have both been tested in Randomized Controlled Trials (RCT) and have both shown significant improvements for people with chronic and complex pain; PRT is awaiting a second larger scale RCT to be completed, while EAET has multiple RCT trials showing benefits over traditional pain management approaches.

Understanding the importance of the bigger picture of pain—how pain is a warning for many different threats in our lives—and how supressing emotions can trigger pain—are key parts of both of these therapies and appear to be helpful for people with CRPS and other types of pain.

Outlook for the Treatment of CRPS

In spite of the preponderance of bad news out there about CRPS, CMR/Safe Sensations, PRT, EAET and Scrambler Therapy are all promising developments for people with CRPS, and they all directly influence the brain, where we now understand pain is created.

During the year I spent at the national CRPS treatment centre, I saw people with long standing CRPS (multiple years of the condition) start to improve, moving their fingers and toes again or being able to stand again or walk better. Now, I am using all of the above treatment approaches with people in an outpatient setting, over a longer time period, and I am seeing even more recovery. Seeing people experiencing “normal feelings” and moving parts of their body they hadn’t moved in months, or even years, are the moments that convince me CRPS is a curable condition. Although I am no longer treating the most severe types of CRPS, when someone comes to me with this diagnosis, my expectation is that they will recover.

Summary Idea: Feeling is Healing