Complex Regional Pain Syndrome
The Theoretical Basis for and Treatment of Complex Regional Pain Syndrome with Prolotherapy
Ross Hauser, MD, Brinker D. The theoretical basis for and treatment of complex regional pain syndrome with prolotherapy. Journal of Prolotherapy. 2010;2(2):356-370.
Complex regional pain syndrome (CRPS) typically refers to post-traumatic pain that spreads from the site of injury, exceeds in magnitude and duration the expected clinical course of the inciting event, and progresses variably over time. Burning pain is the primary symptom, but patients frequently report allodynia, changes in the color or temperature of the skin, and if the condition progresses, trophic changes of the skin, nails, and bone occur. The condition produces a high degree of suffering, lost productivity and cost of treatment. While there are many theories as to why CRPS occurs, success in treatment of CRPS with traditional medical therapies is dismal.
CRPS generally appears following a physical trauma, involving the bone and soft tissues which are treated with long periods of immobility. While this immobility itself may be needed to heal a bone injury such as a fracture, it encourages ligament injuries to not heal. Stress deprivation or immobility causes a protracted state of progressive atrophy and lack of mechanical strength in the injured ligaments. The high density of both myelinated and unmyelinated nociceptors in the non-healed ligaments then become sensitized to the point that even normal or less than normal activities activate them to fire causing severe burning pain. These activated nociceptors through local and feedback loops in the central nervous system, cause autonomic phenomenon in the extremity including referral pain, edema and temperature disturbances. Research by George S. Hackett, M.D., who coined the term Prolotherapy, found that ligament relaxation (his term for non-healed ligament injuries) caused bone dystrophy (osteopenia/osteoporosis), which is a common feature of CRPS. He also noted that ligament relaxation often activated the sympathetic nervous system and that when Prolotherapy was performed to the injured ligament(s), not only did the local pain remit, but so did the autonomic phenomenon. Since traditional treatments do not address non-healed ligament injuries, this entity could be the reason that so many cases of CRPS are never resolved. Since Prolotherapy causes ligament regeneration, it should be in the arsenal of any clinician treating patients with unresolved CRPS symptoms.