4) If they took you on as a patient would they automatically put you into their "pain patient program" or would they be able to customize a program for you based on the needs of an CRPS patient? Would they treat your "chronic pain" differently from "acute pain"?

Many physical therapy clinics are finally coming around on these questions but it is a slow turnaround. First, let us address the difference between acute pain and chronic pain. Doctor Tim Sams in his book called "ABC's of Pain Relief and Treatment", states "Chronic pain is not simply acute pain that doesn't go away", and " If short-term and long-term pain were not the same thing, then why would the treatments for acute pain make chronic pain go away? The answer is that they do not. The treatments for acute pain can be helpful at best and occasionally destructive at worst."

All too often the primary goal of the chronic pain patient in going into physical therapy and the goal of the Doctor/physical therapist are not the same. While the pain patient is seeking to reduce their pain, the medical professionals are simply seeking to increase the ROM (range of motion). If decreased pain is a by-product that is a bonus, but it is all about getting the patient moving again.

This can create problems in that the chronic pain patient becomes discouraged if, within the first three to four weeks they don't feel any decrease in pain, even if their ROM has changed. While the acute-pain patient can see immediate gains, the chronic pain patient needs to look long-term. They need to look 3 to 6 months and more down the road in their physical therapy plan for their first gains because they are in this for the long-haul.

However, what ends up happening in many cases, especially with certain types of insurance and in some WC cases, is that they are told what program to put you in and it is usually the Pain Patient Program. This is a standardized program which is fine for most types of acute pain. It is set on the principle of NO PAIN, NO GAIN! It can involve everything from classroom instruction (many CRPS patients cannot sit for very long without pain), to land therapy, sometimes very aggressive land therapy.

With CRPS, NO PAIN is ALL THE GAIN, as a Doctor friend of mine used to say. The PT program for a CRPS patient must be a combination of Aqua Therapy, a basic water therapy program typically based on the Arthritis Society's Water Therapy Classes, cardio therapy when possible, and ROM exercises. The Aqua Therapy is the most beneficial form of therapy for CRPS patients. It involves stretching, walking, and even some light weights, but all done in a warm water pool. It has the added benefit of reducing allodynia (sensitivity to touch) in most cases as well.

It is important to remember that while the warm packs work very well for most patients they must never be followed by the cold or ice packs as the ice will simply further damage the already weakened myelin sheath surrounding our already damaged nerves. Even though the ice may feel good for a brief time it will end up causing severe damage and repeated use of ice packs or hot/cold contrast therapy will, in many cases, accelerate the CRPS.

5) Where do I start to look for such a Physical Therapist?

The best place to start is in the nearest large hospital. Sometimes you may have to travel an hour or more but if you find the right therapist it is worth it. Since many of your questions can be asked over the phone, call as many places as possible. Don't be put off by the person who answers the phone either. You want to talk to the Director of the clinic if possible or, at the very least, one or more of the physical therapists.

If they can't talk to you right away then leave your name, number, and the reason why you called (looking for a therapist who treats Complex Regional Pain Syndrome), and a time to call you back.

There is nothing wrong with the smaller physical therapy centers but they are less likely to have a therapeutic pool so it is best to stick with the larger hospitals.

Also, talk with your Doctors; your Pain Care Doctor, your GP, etc. Chances are good they know of one they can recommend. 

6) Should CRPS Patients use ICE in ANY part of their Physical Therapy?

The short and long anser is ABSOLUTELY NOT! Not in ice packs, not in hot/cold contrast therapy, not cold packs, not ice in any form! For a more detailed answer read the information regarding CRPS and ICE. It is very important.

Remember, a good Physical Therapist can be a key member of your medical team and play a very important role in helping you get your life back, and a bad one can accelerate your CRPS and possibly even make it worsen and/or spread.

Hopefully this will give you a head start! If you have ideas that you would like to add, send them in to RSDHope@mail.org

The American RSDHope team!

We at American RSDHope are not Medical Professionals. Be sure to discuss with your Doctor any new information before stopping or starting any form of therapy and/or treatment.