This proposal presents the theory that the use of early lymphatic management techniques for patients who suffer from complex regional pain syndrome (CRPS) can limit CNS remodeling, preventing progression of the disorder. In absence of high quality evidence, we interviewed multiple lymphedema therapists to assist in the generation of a lymphatic management protocol for use with patients experiencing CRPS-associated pain and edema.
The pathophysiology of CRPS-associated edema is not fully understood. Potential causes may include vasomotor dysregulation or neurogenic inflammation. Regardless of its cause, edema and pain may lead to excessive muscle guarding and kinesiophobia. Targeting edema early may inhibit progression of the disease before pain becomes centrally mediated.
Lymphedema therapy, including manual lymphatic drainage (MLD) and compressive garments, is commonly used to treat patients with compromised circulatory or lymphatic systems. Based on a limited number of low quality studies, MLD has shown conflicted results for improvement of CRPS symptoms. However, these studies have evaluated MLD as an isolated treatment rather than as a component of a comprehensive treatment protocol. None of these studies have investigated the effect of compression garments or early intervention. In light of the limited available research on this topic, expert opinion may provide further insight into the effectiveness of this modality. To support the plausibility of our theory, we have interviewed experienced lymphedema therapists who have treated CRPS with a combination of MLD and compression garments as part of a comprehensive PT treatment plan.
Lymphatic drainage applied proximally to the affected limb creates a negative pressure gradient that draws out edematous fluid, providing relief from symptoms without needing to touch the edematous limb. With less pain and discomfort, patients have greater potential to gain functional mobility, which can prevent further complication. Compression garments maintain the pressure gradient for longer treatment effects; interviewed experts report that individual patients have tolerated their use. Traditional protocol for lymphatic drainage is followed for CRPS patients, including teaching independent care, though progression may be slower. No additional contraindications or precautions for the CRPS population were identified.
The incorporation of lymphatic management into a comprehensive treatment plan allows for additional tools to decrease disability in CRPS patients with edema. Knowledge of this modality as a treatment option may help improve physical therapy outcomes. Learning to manage CRPS symptoms will help patients decrease kinesiophobia and increase functional capacity.
University of Puget Sound
Armstrong, Sarah; Look, Jake; Christie, L. Fletcher; and Allen, Roger, "Lymphedema Therapy for the Treatment of Complex Regional Pain Syndrome" (2016). Physical Therapy Research Symposium. 23.