I have been researching Complex Regional Pain Syndrome and have found conflicting information on contrast bath. Some sources say that it is beneficial, while others say it can lead to disease progression. If anyone has any insight please share. Please let me know if you have any suggestions on how to treat this condition.
Joined: February 14, 2003
From: Madison WI USA
The answer is that it may be beneficial, AND it may lead to disease progression. It is doubtful that these studies had enough subjects to draw useful conclusions. Convincing the patient that the pain they are getting is from abnormal response to non-painful stimuli, and hence re-training of the nerve(s) is painful, but necessary is the key to helping. Once the patient starts to believe that all pain is bad, and cant get themselves to do anything toward recovery, meaning they stop moving completely in the affected part, things can get very bad. These patients need to have every portion of the rehab team working, and on the same page, including the health psychologists. If they dont have this going, talk to the doc to make it so.
Tough dx. Shill is spot on however. This has to be a multidiscipline effort.
I would suggest avoiding passive treatments if at all possible. This simply facilitates the disease process in my opinion. I would encourage activities that involve the affected area as well as its contra lateral partner. Giving ownership to the affected area is key to getting anywhere with these patients. They will come to therapy for months/years and hand their affected part to you for passive treatment as long as you facilitate that. PROM, baths etc may elicit a positive response from the patient but is doing little to affect the disease process. Low resistive "graded" bilateral activities work well. Be creative. Fluidotherapy with or without heat is nice if available. Do not use the passive version of this however by simply placing the limb part in the unit. Have them manipulate and/or move the part during the treatment while in the unit.
A very challenging group to work with and unfortunately little to guide us at this point. Take advantage of what we do know however and use those facts to guide the treatment process as best possible.
What we do know: Roughly 80% of RSD patients are female b/t the ages of 30-35 and/or 44-50. There is obviously some interesting pathology underlying this.
They often treat the affected part as a separate entity and can even go as far as naming the affected part and referring to it as such. Put an end to that if possible.
They (women especially) are very susceptible to osteoporosis from in-activity of the part and this can become very serious if not dealt with medically. A screening for OS is important as early as possible and should be closely followed.
They commonly miss appointments and this should be dealt with from the get-go. This falls into the ownership (Active vs Passive) roll mentioned early.
Keep the therapy sessions unpredictable. Change up the treatments when possible and the treatment times.
Shill is bang-on. Check into "MIrror-box" treatment. And don't be afraid to use your hands - in a gentle fashion, on the neural "feed" channels for the extremity. In U/E, the neck and thoracic outlet area, in the lower, the groin and popliteal area. Manual gentle handling of a patient is not truely "passive" - it engages the patient's neural system, including the brain (a darn handy tool to engage in any condition) and the immune system. The mirror box can help enormously. There are nice descriptors available on NOIgroup and when you Google "mirrorbox".
Joined: November 15, 2003
Mirror box therapy is the only method that has some predictability of outcome. No complex equipment, and some astounding results. Check it out - it is gradually being used world-wide, from what I gather, thanks to the work of Ramachandran et al.