CRPS (complex region pain syndrome) is a peripheral pain disorder of the limb that most commonly develops after injury or surgery. CRPS is a severe pain disorder with sensory, motor, autonomic and trophic symptoms and signs. The diagnosis is based on the findings of the clinical examination, the patient’s history and symptoms, and the exclusion of other possible causes of the symptoms. There are two subtypes of CRPS: CRPS I occur without nerve damage, and CRPS II occurs after known nerve damage. The symptoms are diverse and may change over time with treatment and rehabilitation. (1).
Typical symptoms of CRPS are:
- continuous pain
- increased sensitivity to painful stimuli
- feeling in pain from stimuli that are usually painful (e.g., touch)
- temperature variation between limbs and/or skin color changes/asymmetry
- swelling and/or changes in sweating/asymmetry
- limited range of motion and/or motor impairment (3)
The aim of CRPS rehabilitation measures is to relieve pain, improve functional capacity and quality of life, and prevent the long-term effects of CRPS. These goals can be achieved by rapidly identifying the syndrome and initiating treatment and rehabilitation measures without delay (1). The most common physiotherapy method is therapeutic training, in which the exercises are functional and improve range of motion. Other physiotherapy methods, such as brain and sensory exercises, cognitive-behavioral therapies, mindfulness exercises and multidisciplinary pain management programs, are also in active use. (2).
Chronic pain causes changes in cerebral cortex and motor cortex function. Continuous pain impulses cause hyperactivation of the motor cortex, resulting in a reduction in normal limb function, with limited joint mobility, reduced active muscle pump activity and increased swelling. The aim of lymphatic therapy is to increase lymphatic drainage, thereby reducing tissue pressure and pain receptor irritation due to swelling. The equalization of pressure changes the sensation of the whole CRPS limb. The sensation provided by lymphatic therapy acts as a sedation therapy by stimulating the motor areas of the CRPS patient’s brain and providing sensory stimulation. This is based on the plasticity of the brain, which is why it is important that lymphatic therapy is painless. (5). Edema treatments have been used as part of the rehabilitation of CRPS patients. The methods used to treat swelling have reduced swelling and pain and increased active mobility of limbs. (4).
Lymphatic drainage therapy with CRPS patients is started from the body to see how the patient’s body reacts to increased lymph circulation. After that, one can proceed to the treatment of the sensitized limb. In the case of a highly sensitized CRPS limb, lymphatic drainage can be performed using mirror neurons, i.e., lymphatic drainage treatment can be performed on the healthy side. (5)
LymphaTouch has also found its place in the rehabilitation of CRPS patients. The negative pressure and lifting the tissue created by LymphaTouch activates lymph circulation even at low negative pressures. It is advisable to start LymphaTouch treatment with low negative pressures and, if necessary, increase the negative pressure according to the patient’s sensations.
Pihlajalinna’s physiotherapist Viivi explains how she uses LymphaTouch in her CRPS patients:
I have been using LymphaTouch as part of my treatment for CRPS patients for 10 years now. I do edema treatments with LymphaTouch in CRPS patients because I am not lymph therapist. If there is a very sensitive and painful patient, I refer the patient to a colleague who has been trained in manual lymphatic drainage therapy for the first start of lymphatic drainage.
If the manual lymphatic drainage has a good response and the patient tolerates it, I start lymphatic drainage treatment with the device. The important thing is to always stay in a painless or patiently tolerable range and intensity. When treating patients with CRPS, treatment always starts from the painless area, upper aperture area (clavicular fossa, armpit), shoulder and abdomen, and possibly from the healthy limb area. If the treatment in these areas is tolerable, the treatment is directed towards the painful limb.
Some upper limb CRPS patients can tolerate manual lymphatic drainage from the sore upper limb down to the palm of the hand, but with LymphaTouch it may be necessary to leave the treatment in the upper arm or upper forearm area, and its lower limb will not progress. Depending on the patient’s tolerance, the treatment can be extended down to the hand and palm. Similarly, the lower limb CRPS patients often tolerate treatment up to mid-leg. The ankle area does not always tolerate treatment because of the pain, so treatment of the sole of the foot is well tolerated by many.
CRPS patients have large day-to-day differences in pain, so treatment is always done according to the situation of the day, staying in a painless or tolerable area for the patient. On a painful day, many patients have found the treatment of the upper repertoire, abdomen, and shoulder area relaxing, and it already stimulates the body’s lymph circulation and produces positive effects even in the painful limb. CRPS patients of the upper limb often benefit from releasing the muscles of the shoulder gridle, and in this area even higher pressure values can be tolerated with LymphaTouch and it is often perceived pleasant.
- Duodecim. 2017. Regional pain syndrome. https://www.duodecimlehti.fi/duo13888
- Miller, C., Williams, M., Heine, P., Williamson, E. & O’Connels, N. 2019. Current practice in the rehabilitation of complex regional pain syndrome: a survey of practitioners. Disability and Rehabilitation. Volume 41. https://doi-org.ez.lapinamk.fi/10.1080/09638288.2017.1407968
- International Association for the Study of Pain. Classification of chronic pain. 2nd edition (revised). www.iasp-pain.org/files/Content/ContentFolders/Publications2/ClassificationofChronicPain/Part_II-A.pdf
- Safaz, I., Tok, F., Taskyanatan, M.& Ozgul, A. 2009. Manual lymphatic drainage in management of edema in a case with CRPS: why the(y) wait?. Rheumatol Int (2011) 31:387–390 DOI 10.1007/s00296-009-1187-x.
- Lyko magazine. 2011. Manual lymphatic drainage relieves pain in CRPS. Written by Anne Anttila (PhD, lymphatherapist) & Heli Turkey (PhD, lymphatherapist)