Monthly Archives: May 2013

Complex Regional Pain Syndrome

According to Wikipedia:

Complex Regional Pain Syndrome (CRPS) is a multidisciplinary syndrome, which often initially affects an arm or a leg and often spreads throughout the body.

Recent evidence has led to the conclusion that Complex Regional Pain Syndrome is a multifactorial disorder with clinical features of neurogenic inflammation, nociceptive sensitisation (which causes extreme sensitivity or allodynia), vasomotor dysfunction, and maladaptive neuroplasticity, generated by an aberrant response to tissue injury.^[3] Treatment is complicated, involving drugs, physical therapy, psychologic treatments and neuromodulation and usually unsatisfactory, especially if begun late.

Type I was formerly known as reflex sympathetic dystrophy (RSD), Sudeck’s atrophy, reflex neurovascular dystrophy (RND), or algoneurodystrophy, does not have demonstrable nerve lesions. With the vast majority of patients diagnosed with CRPS being of this type, most of the literature thus refers to type I.

Type II, formerly known as causalgia, has evidence of obvious nerve damage.

Symptoms:

These stages may not be time-constrained, and could possibly be event-related, such as ground-level falls or re-injuries in previous areas. It is important to remember that often the sympathetic nervous system^[46] is involved with CRPS, and the autonomic nervous system can go haywire…

Stage One : severe, burning pain

1. Muscle spasm,
2. joint stiffness,
3. restricted mobility,
   
4. rapid hair and nail growth, and
5. vasospasm (blood vessel spasms).

The vasospasm is that which causes the changes in the color and temperature of the skin. Some may experience hyperhydrosis (increased sweating). In mild cases this stage lasts a few weeks, in which it can subside spontaneously or respond rapidly to treatment (physical therapy, pain specialist)

Stage Two : more intense pain.

• Swelling spreads,
• hair growth diminishes, nails become cracked, brittle, grooved, and spotty,
  
• osteoporosis becomes severe and diffuse,
  
• joints thicken, and
  
• muscles atrophy.

Stage Three :  irreversible changes in the skin and bones, while the pain becomes unyielding and may involve the entire limb. There is

• marked muscle atrophy,
• severely limited mobility of the affected area, and
•  flexor tendon contractions (contractions of the muscles and tendons that flex the joints).

Occasionally the limb is displaced from its normal position, and marked bone softening and thinning is more dispersed.

One simple description from a healthcare practitioner – put into layman’s terms:

RSD is like having a part of the body go in to shock. The involuntary nervous system which controls blood vessels and sweating goes in to hyper-drive. Blood vessels constrict, squeezing the blood toward the core of the body, as if the body is trying to protect itself from a life-threatening trauma or blood loss. The affected extremity becomes cold and painful. Symptoms spread as the nervous system gets stuck out of balance  in a destructive and painful loop.

The treatment is multidisciplinary.  In the context of Herbalism, this post takes a look at herbs that can be one part of an integrative treatment plan.

Herbal approach

With herbs we are not stating that we can cure a complex syndrome.  What we are taking a look at is what herbs can support the body when it undergoes these conditions outlined in the stages above:

1. Sympathetic nervous system
2. Pain and swelling of extremities
3. Hair and Nails
4. Osteoporosis, bone softening
5. Muscle atrophy and muscle spasms

Sympathetic nervous system and swelling of extremities

Let’s take a look at which of these 5 symptoms above are of primary concern:

Sympathetic nervous system, spasms and swelling of extremities

There are a number of herbs which calm the nervous system. We chose Skullcap over Valerian because Skullcap is known to cool the body of Excess or Deficient Heat.

We add Cleavers, because of the swelling of the extremities.  Cleavers is considered a very effective herb for the treatment of swollen lymph nodes.  Cleavers also has an affinity for the flexor areas (see Stage Three).  Together, Cleavers targets the flexors and Skullcap calms them.

Skullcap ~ Scutellaria laterifolia

Properties: Nervine, anti-spasmodic, sedative, hypotensive

Minerals: High in calcium, potassium, magnesium.

Skullcap’s primary use is as a nervine herb, which strengthens and quiets the entire nervous system.  It gives immediate relief in all chronic and acute nervous conditions, including

• muscle spasms
• twitching, and
• tremors
• neuralgia
• muscular weakness.

Cleavers ~ Gallium aparine

Swollen lymph nodes in the extremities can be treated with an herbal lymphogogue.  Cleavers is a safe yet effective lymphogogue which is mildly sedation (good for treatment of pain) (4)

Cleavers has a predilection for flexor surfaces like the bend of the forearm, the axilla and the back of the knees. (3)

Main herbal actions: Alterative, diuretic, anti-inflammatory, lymphagogue

Main medicinal uses:  increase urine flow to relieve fluid retention, and treatment of enlarged or infected lymph nodes

Hair and Nails ~ Osteoporosis, bone softening

These conditions may appear secondary to why they may be occurring. The condition of Hair and Nails, Osteoporosis and bone softening – we have selected Horsetail and Nettle to treat these deficiencies, which may also support the underlying conditions.

Horsetail ~  Equisetum arvense

Horsetail is known as a high source of digestible silicon, which has a same electron structure to calcium.
It contains 5-8% silica, potassium, manganese, flavonoids, phenolic acids, organic acids and saponins (3)

Horsetail is used to:

• strengthen and restore bone, joint cartilage and tissue health.
• relieve fluid retention which will assist with the swelling.
• treat brittle nails
• stimulate hair growth
• treatment of gout

Horsetail due to it’s silicon content, Horsetail is related to this study on Silica and Bone Health in PubMed:

Silicon is suggested to be integrally bound to connective tissues and their components and to have an important structural role, as silicon deprivation studies have reported detrimental effects on these tissues…  silicon supplementation has been reported to have beneficial effects on these tissues especially bone where much of current work has concentrated.

Nettle ~ Urtica dioica

Nettle works well to assist in the bio-availabilty of nutrients in Horsetail.  Nettle is also used for:

• Joint ailments
• Poor circulation
• Diabetes
• Wound healing
• Internal bleeding
• Water retention
• Anemia (Nettle is a very high source of digestable iron)
• Benign Prostatic Hyperplasia (BPH)
• Osteoarthritis – when combined with anti-inflammatory herb

In this case we are electing to use Cleavers as the anti-inflammatory herb which also clears swollen lymph.  Cleavers combined with Nettle can be used to reduce the inflammation of swollen joints.

For cases with patients with diabetes, Nettle combined with Huckleberry Leaf can be used to lower blood sugar levels

References:

1. Wikipedia
2. Healing with the Herbs of Life, by Leslie Tierra – page 120-121
3. Herbs from the Earth by Sharon Tilgner N.D.
4. Web MD – Gallium aparine ~ Nettle
5. PubMed Silicon and Bone Health PMCID: PMC2658806