Yoga Therapy for Complex Regional Pain Syndrome

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Based on our experience working with numerous people facing Complex Regional Pain Syndrome, we are pleased to share some information and yoga tools that you might find helpful. Of course, every person is unique, and this is we know very well in yoga therapy, where based on the individual’s needs, energy level, body, breathing pattern, character, lifestyle and beliefs we develop a personalized graded holistic practice.

CRPS is a chronic condition as a result of a trauma or injury characterized by a disproportionate pain and disability leading to depression and isolation (Shim et al., 2019). The pain may spread to the entire arm or leg, even though the injury might have only involved a finger or toe.

CRPS is a multifactorial chronic pain syndrome. There is a higher risk for developing CRPS after a fracture (and especially an antebrachial one), pre-existing rheumatoid arthritis, pre-existing musculoskeletal conditions such as low back pain (Beerthuizen, 2012), limb immobilisation (Marinus, 2011) and prolonged general anaesthesia during surgery (Birklein et al., 2018), although occasionally it is developed with no incident. Besides the central sensitisation, psychological factors such as neurotism, depression, anxiety and anger contribute to its development (Beerthuizen, 2012). 

Complex Regional Pain Syndrome has main symptoms; constant disproportionate pain, hypersensitivity to touch, the inability to move/function, changes in temperature and sweating, starting warm and if it gets chronic the limb is always cooler.

It appears more in women than men (4:1), with an average age in the 50s, the upper limb is affected twice as much as lower limbs.  CRPS I is much more common accounting for 88% of cases. This is where the nerves are not affected. While in CRPS II,12% of cases is where the nerves are affected.

The main initiating events are injuries (motor vehicle accidents, falls, struck by object etc.), surgeries, stroke, although there might be no identifiable initiating event.

CRPS is different from other chronic pain syndromes by the fact that there is a dysfunction of the sympathetic autonomic nervous system maintaining the pain, persistent regional inflammation as well as cortical reorganisation as in stroke and phantom limb pain patients (Bruehl, 2010). Reports have shown a smaller representation of the affected limb in the somatosensory cortex (Juottonen et al., 2002).

Based on Cochrane systematic reviews on CRPS (Smart, 2016), the most effective intervention seems to be the Gradual Imagery Intervention (GMI) or Motor Imagery Program (MIP), (Moseley, 2004) with pain reduction of more than 50% being achieved. It consists of 2 weeks with the limb laterality phase, 2 weeks with the imagined movements phase and the last 2 weeks with the mirror movement phase.

Based on the robust RCT of Moseley (2004), the 1st phase has no movements, or visualisation of movements and patients only recognise a pictured hand to be left or right, activating the representation of the limb in the brain. In the 2nd phase of the imagined movements phase, the patients are asked to imagine that they move their affected hand.  In the 3rd phase the patients were asked to move both hands with the affected hand concealed from a mirror box while the patient is watching the unaffected hand moving on the mirror while she/he is moving both.

Based on that, the yoga therapy explored with very beneficial results were 2 weeks of daily yoga nidra focusing on the upper limbs and especially on the right arm, 2 weeks of visualisation of movements and 2 weeks moving both arms, looking only at the unaffected one, and then 2 weeks moving and watching both.

This is another successful example of integrating yoga therapy, physiotherapy, neuroscience and evidence-based information through evaluation of robust and updated research articles. for details of IAYT Accredited 800 hours Yoga Therapy Training, personal and group yoga therapy sessions

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