CRPS the Proof of Brain Plasticity
Updated: Nov 20, 2021
What is CRPS you ask? Well to be honest, I can tell you what it stands for but explaining it can be a challenge. CRPS remains a very peculiar, yet super significant condition.
CRPS stands for "Chronic Regional Pain Syndrome" which usually develops following a fracture, sprain or surgery however there are documented cases of spontaneous onset.
Let's say you fracture your wrist after falling on the ice. There will be bruising, swelling, decreased strength, pain etc. Any slight movement of your wrist will cause extreme pain. This acute pain is good; it is designed to be protective and reminds us to be careful while the body works its magic through the healing stages. After approx. 6-8 weeks after being in a cast, your bone will be healed and you can start movement and progressive strengthening. Great! Okay but what happens if the bone is healed but the signs and symptoms continue? What if the swelling continues and spreads into your forearm? What if you begin to experience intense pain with the slightest movement or touch? What if this continues for the next 6 months or even year? This is an example of CRPS and you can see how disabling it may become. It remains unclear why some people develop CRPS and why some people don't.
The diagnosis of CRPS is not straight forward but involves self-reported symptoms and observed signs during clinical examination. CRPS typically presents itself as continuous pain that is disproportionate to the tissue damage (if any), combined with an altered range of physical and cognitive functions. Someone with CRPS can present with spontaneous and random pain that can be constant or change with activity, intense pain can be felt with as little as a light touch, changes in skin temperature and colour, abnormal swelling, excessive sweating, burning sensations etc. Long story short, it can look as if someone has significantly injured a body part, yet nothing is injured at all. So what the flip is going on?
Chronic Regional Pain Syndrome is considered to be a pathological pain condition. There is evidence to support changes in the central nervous system (spinal cord and brain) in people with CRPS. There is pain-related reorganization in the brain which can result in minor inputs (ex moving your wrist in the slightest way) turning into large outputs (ex. burning sensation, swelling, intense pain etc). Essentially nerves that fire together, wire together.... The nerves involved in wrist movement and the nerves involved in pain become one. Once these are wired together, you can elicit the pain response just by thinking about moving your wrist! So now the question is, how the double flip do we treat this?! The answer is pretty damn cool!
The changes in the brain (or neuroplasticity) that is observed in CRPS are reversible! Without getting into too much detail, there are specific techniques to unwire these nerves. Graded Motor Imagery is a method to trick your brain that you are moving the affected body part without causing pain. The goal of this process is to progressively activate the motor cortex (that was previously linked to the pain response) without actually evoking a pain response. Graded Motor Imagery is a 3 step process that involves looking at pictures of the body part and distinguishing between left and right, then imagining that body part moving, then watching the non-affected body part move in a mirror. This creates a pain-free illusion of movement of the affected limb. Lets explain this process further with an example:
Anna is suffering from CRPS of her left hand for almost a year now. Anna's treatment starts by looking at pictures of healthy left and right hands and distinguishing which is left and which is right. Next, Anna would choose a picture of a healthy left hand and imagine it moving. Lastly, while covering her left (affected) hand, she would place her right hand beside a mirror and begin to move it. Eventually, with enough time, patience and repetition this actually works! Tricking the brain essentially becomes Anna's new and improved reality!
Personally, I find this fascinating!
The main message I wanted to share from this post is just how powerful our thoughts can be and the concept of neuroplasticity. Once we truly understand this, this concept can be applied to much more than just CRPS.
To be continued.
Monika Halicka, Axel D. Vittersø, Michael J. Proulx, Janet H. Bultitude,"Neuropsychological Changes in Complex Regional Pain Syndrome (CRPS)",Behavioural Neurology,vol. 2020,Article ID 4561831,30pages,2020.https://doi.org/10.1155/2020/4561831