Medical Cannabis for Chronic Regional Pain Syndrome

What is Chronic Regional Pain Syndrome?

Chronic Regional Pain Syndrome (CRPS), also known as complex regional pain syndrome, is a type of chronic pain that is intense, ongoing, and debilitating. It is usually limited to one limb, but in some situations, it can affect numerous limbs.

It’s a broad term that refers to a variety of reasons and events. Chronic Regional Pain Syndrome is most commonly caused by an injury or trauma, such as a car accident or a stroke.

What are the symptoms of Chronic Regional Pain Syndrome?

Chronic pain is the most common sign of CRPS. People suffering from the condition frequently encounter specific flare-ups, which can last anywhere from a few days to a few weeks and cause the pain to worsen. These can also be brought on by stress.

Otherwise, there are other pain symptoms outside of chronic pain that may present themselves. These include:

  • A burning sensation
  • A stabbing sensation
  • A stinging sensation
  • A mix of all three of the above
  • Sensitive skin in the affected area
  • Hyperalgesia, or feeling pain from pressure or temperature that would not normally be painful
  • Allodynia, or experiencing pain from a very light touch of the affected skin
  • Ghost sensations in the affected limb

People with Chronic Regional Pain Syndrome may also experience symptoms unrelated to pain, such as:

  • Alternating changes to the skin in the affected limb, such as becoming hot, red, and dry at times, whereas other times it may be cold, blue and sweaty
  • Hair and nail changes
  • Oedema, or joint stiffness and swelling in the affected limb
  • Tremors and muscle spasms
  • Difficulty moving the affected body part
  • Insomnia
  • Small patches of fragile bones, also called osteoporosis, in the affected limb
  • Skin infections and ulcers
  • Muscle atrophy, where the muscles begin to waste away
  • Muscle contractures, where the muscles shorten and lose their normal range of movement

Living with CRPS can also have a negative impact on one’s mental health. Managing the symptoms of chronic pain, like any other chronic pain condition, can create stress and worry or depression in the sufferers. As a result, many mental health issues may present their own symptoms and obstacles.

What causes Chronic Regional Pain Syndrome?

Chronic Regional Pain Syndrome usually occurs within one month of trauma or injury. They can be minor or serious, including:

  • Bone fractures
  • Sprains and strains
  • Burns
  • Cuts

The pain and other symptoms will usually affect the limb where the injury took place, but can spread to affect other areas of the body as well. It has also been known to occur when a limb has been immobilised for a long period of time, such as in plaster after a broken bone.
It’s thought that CRPS is an abnormal response to trauma that causes several of the body’s systems to malfunction. It’s also thought that a person’s genes may make them more predisposed to developing CRPS, but it’s unlikely to what extent this is true.

What treatment options are available for Chronic Regional Pain Syndrome?

As there’s no known cure for Chronic Regional Pain Syndrome, treatment focuses on managing symptoms and seeking a reduction in chronic pain. To that end, doctors usually recommend a combination of physical treatments, medicine, and psychological support to help manage the symptoms.

The NHS estimates that around 85% of people with CRPS slowly experience a reduction in their pain and some of their symptoms in the first two years from beginning treatment. However, there is no way to predict who will experience these results.

Medications used to manage pain symptoms and treat Chronic Regional Pain Syndrome include:

  • Non-steroidal anti-inflammatory drugs (NSAIDs)
  • Anticonvulsants
  • Tricyclic antidepressants
  • Opioids

What treatment options are available for Chronic Regional Pain Syndrome?

Chronic Regional Pain Syndrome (CRPS) is a complex and often challenging condition to treat. Treatment approaches vary based on the severity of symptoms and the individual patient’s response. Here are some common treatment options for Chronic Regional Pain Syndrome:

  1. Physical Therapy: Physical therapy focuses on improving mobility and function. Therapists may use techniques like desensitisation exercises, mirror therapy, and gentle exercises to reduce pain and improve limb function.
  2. Occupational Therapy: Occupational therapists help patients with CRPS perform daily activities by teaching adaptive techniques and providing assistive devices if needed. They also focus on pain management strategies during daily tasks.
  3. Medications: Pain relievers, anti-inflammatory drugs, and anticonvulsant medications may be prescribed to manage pain and reduce inflammation. In some cases, antidepressants or antipsychotic drugs can help manage pain and improve mood.
  4. Sympathetic Nerve Block: This procedure involves injecting an anesthetic near the spine to block sympathetic nerves and alleviate pain. It is often used in the early stages of CRPS.
  5. Spinal Cord Stimulation: Spinal cord stimulation involves implanting a device that sends electrical impulses to the spinal cord, disrupting pain signals. This treatment is considered for patients with severe, unmanageable pain.
  6. Ketamine Infusion Therapy: Ketamine, an anesthetic, is sometimes used in controlled doses via intravenous infusion to alleviate CRPS symptoms, particularly in cases resistant to other treatments.
  7. Graded Motor Imagery (GMI): GMI is a therapy that involves mental visualisation and exercises to retrain the brain, helping reduce pain and improve function.
  8. Psychotherapy: Chronic pain conditions like CRPS can lead to emotional distress. Therapy, such as cognitive-behavioral therapy (CBT), can help patients cope with pain, anxiety, and depression.
  9. Alternative Therapies: Some patients find relief through alternative therapies such as acupuncture, biofeedback, and chiropractic care. While not scientifically proven, these methods might provide some individuals with subjective relief.
  10. Lifestyle Modifications: Healthy lifestyle choices, including regular exercise (within pain tolerance), stress management, and adequate sleep, can contribute to overall well-being and potentially improve CRPS symptoms.

It’s important to note that the effectiveness of treatments can vary from person to person. A multidisciplinary approach, involving healthcare professionals from various fields, is often necessary to address the complex nature of Chronic Regional Pain Syndrome. Patients should work closely with their healthcare providers to develop a personalised treatment plan tailored to their specific needs and symptoms.

How can medical cannabis help with Chronic Regional Pain Syndrome?

A study from the United States in 2019 showed that patients suffering from chronic pain experienced a significant reduction in pain symptoms when treated with medical cannabis. For those living with Chronic Regional Pain Syndrome, medical cannabis could be an alternative form of treatment that offers much-needed relief.

Opioids are often a common choice for helping with chronic pain. Medical cannabis is already being put forward by experts as an alternative medication to opioids, reducing the risk of developing a dependency and other unwanted side-effects. What’s more, this study from 2012 states that cannabis can help lead to a greater cumulative relief of pain. That means fewer opiates are used and reduces the impact of the associated side-effects.

Medical cannabis, also known as medical marijuana, has been a topic of increasing interest in the realm of chronic pain management, including conditions like Chronic Regional Pain Syndrome (CRPS). While research on the specific effects of cannabis on CRPS is still ongoing, some potential benefits have been identified based on existing studies and anecdotal evidence. It’s essential to note that individual responses to medical cannabis can vary, and consulting with a healthcare professional is crucial before considering any form of treatment. Here are some possible benefits of medical cannabis for CRPS patients:

  1. Pain Relief: One of the most recognised benefits of medical cannabis is its potential to alleviate chronic pain, including neuropathic pain associated with CRPS. Cannabis contains compounds called cannabinoids, which interact with the body’s endocannabinoid system and may help modulate pain signals.
  2. Anti-Inflammatory Properties: Cannabinoids, particularly cannabidiol (CBD), have anti-inflammatory properties that could potentially reduce inflammation in affected areas, which is a common feature of CRPS.
  3. Muscle Relaxation: Medical cannabis might help CRPS patients by relaxing muscles, reducing muscle spasms, and promoting a sense of overall relaxation. This can be especially beneficial for individuals experiencing muscle stiffness and tension.
  4. Improved Sleep: Chronic pain conditions often disrupt sleep patterns. Medical cannabis, when used in specific strains and dosages, may help CRPS patients improve the quality of their sleep, allowing for better rest and potentially aiding the body’s healing processes.
  5. Anxiety and Stress Reduction: CRPS can lead to increased levels of anxiety and stress. Some components of cannabis, such as CBD, have anxiolytic properties and might help patients manage these psychological symptoms.
  6. Appetite Stimulation: Loss of appetite is a common issue for individuals dealing with chronic pain. Certain strains of medical cannabis can stimulate appetite, potentially helping patients maintain a healthier diet and improve overall well-being.
  7. Neuroprotective Effects: Some studies suggest that cannabinoids have neuroprotective properties, which means they could protect nerve cells from damage. In the context of CRPS, this neuroprotective effect might be valuable in preventing further nerve damage and managing symptoms.
  8. Distraction from Pain: Medical cannabis can alter perception and mood, providing a temporary distraction from chronic pain. This psychological relief can improve a patient’s overall quality of life.

It’s important for CRPS patients to work closely with healthcare professionals experienced in medical cannabis use. A healthcare provider can help patients determine the appropriate dosage, administration method (such as oral ingestion, vaporisation, or topical application), and monitor for potential side effects or interactions with other medications. Additionally, patients should be aware of the legal status of medical cannabis in their region and follow all applicable laws and regulations.