What is the role of protective disuse in the development of complex regional pain syndrome (CRPS)?

Updated: Jun 20, 2018
  • Author: Gaurav Gupta, MD; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Answer

Decreased use of an injured body part would appear to be a normal postinjury reaction. After injury, the organism protects and guards the injured body part to optimize healing and prevent reinjury. A normally healing organism gradually increases its use of the injured region, which aids in recovery and reintegration of the body part into the organism’s normal sense of self. However, excessive protection and guarding, such as casting or splinting, is commonly promoted by care providers, increasing the patient’s disuse of the extremity and promoting fear-avoidance, which may progress into a neurological neglect-like syndrome.

This phenomenon has been postulated as a cause in some patients with CRPS. [44] Many of the symptoms and signs of CRPS are consistent with those that would naturally develop from lack of use. For example, an unused dependent limb eventually develops swelling (dependent edema), coolness (decreased blood flow), and trophic changes (decreased blood flow). [14, 1, 46]


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