New Treatments for CRPS: Ivy’s Story
CRPS is an awful disease. Picture this: you injure yourself or get injured, and then instead of healing, this turns into a bonfire of pain that you can’t get rid of or control. Even a big breeze can set this off. It’s a miserable experience. However, we have been working for years on new treatments for CRPS, and this one involves using the growth factors from your own blood platelets. Let me explain.
What Is CRPS?
CRPS has had many names through the years, like causalgia, RSD (reflex sympathetic dystrophy), and sympathetically maintained pain. The acronym CRPS stands for complex regional pain syndrome. There are two main types. Type 1 is often unexplained, but type 2 is the one we’re discussing here today, which is caused by nerve injury. This is a disease where the nerves carrying pain signals spin out of control because the natural braking mechanism for pain is not functioning.
Think of your pain-control system as nerves that carry pain signals and then another system that can put the brakes on those signals. For example, if a bus was about to run you over, your adrenaline would kick in, and even though you had foot pain, you would suddenly find yourself across the street and away from the bus without your foot having hurt. In that instance, the nerves that control your pain (which are located in the sympathetic nervous system and in other areas) spring into action to reduce the pain signals so you can act.
This same pain control system is active every day. In fact, one of the problems with taking narcotic pain medications is that it tends to rewire this system and reduce its efficiency over time, hence, increasing the pain signals. However, if this pain control or braking system isn’t working, then the pain can climb out of control to new heights. That’s CRPS.
This type of CRPS is caused by a nerve injury. It’s also called causalgia. Basically, the nerve injury leads to the out-of-control pain signals through a complex mechanism that’s not yet completely understood.
Treatments for this problem are generally poor and span the gamut from physical therapy to medications to invasive therapies, like implantable stimulators. None of these therapies work well, which is even worse for patients with CRPS because they’re in severe pain with few options. However, we began treating CRPS patients many years ago with precise ultrasound-guided nerve hydrodissection using platelet lysate. What’s this and how does it work?
What Is Platelet Lysate?
You may have heard about the cousin to platelet lysate called platelet-rich plasma, or PRP. Many athletes use this concentrated platelet therapy to help nagging injuries heal through just injections without surgery. Platelet lysate involves removing the healing growth factors from the blood platelets and then just injecting those with the serum. Why? The immediate growth factor levels are much higher. To learn more, see my video below:
Platelets contain two growth factors involved in nerve repair: NGF and brain-derived neurotrophic factor (BDNF) (ref 1). They also contain many other growth factors involved in tissue repair. Could this help damaged nerves repair? Recently, a controlled study determined that concentrated platelets carefully injected using ultrasound guidance around the injured median nerve in patients with carpal tunnel syndrome improved the nerve function.
What Is Nerve Hydrodissection?
Think of a nerve as a big garden hose. There is a nucleus and other cell organs that produce the nourishment at one end for the very long and thin nerve cell at the other one end. This is like a hose attached to the spigot where the rest of the garden hose carries the water to the other end of the hose. When you step on one part of the hose, less water comes out the end. Similarly, when one part of the nerve axon (the hose part) is scarred down, the stuff that must travel along its course to keep the whole nerve cell healthy is reduced.
How does the nerve get a scarred-down or restricted spot? We often see that direct nerve injury or tight spaces where the nerve must traverse can produce scarring. This can be treated by carefully injecting fluid (in this case platelet lysate with nerve growth factor) around the nerve to break up this scarring. To see what this looks like, watch my video below:
Ivy’s Story of CRPS
Ivy is a pediatric nurse practitioner who had the nerve on the top of her hand injured during an IV start. This nerve injury caused CRPS type 2 with severe pain and inability to use the hand. This got so bad that her inability to use that hand and arm led to a frozen shoulder. In 2016, she flew out to Colorado from the Carolinas, where I diagnosed CRPS type 2 and then performed a platelet lysate hydrodissection of this nerve using precise, high-definition ultrasound guidance (the nerve is very small). I also treated irritated nerves in her neck and the frozen shoulder, both using X-ray-guided platelet lysate injections.
She reported significant improvement about a month after the treatment and continued to get slowly better over the entire course of her hydrodissection treatments. For example, her grip strength went from 10 pounds just after the injury to 41 pounds after occupational therapy to 65 pounds just after the hydrodissection! Just this month, she e-mailed me: “I just realized despite the flu. Despite being back at work and busy. Despite many reasons- my hand is pain free.” This is an earth-shattering result for a CRPS patient as these patients are often poorly responsive to treatment and it’s very, very rare to see any that become completely cured.
The upshot? CRPS is one of the most difficult problems to treat in medicine. We’re happy to say that we have been using these precise orthobiologic therapies to treat CRPS now for years with very good results considering these patients often respond to few therapies. We’re so happy that Ivy is pain-free, and I asked her if I could share her story here so that others can have hope and have access to these new treatments for CRPS.