Treating Complex Regional Pain Syndrome Using Counterstrain: A Novel Approach

Complex regional pain syndrome (CRPS) is a challenging disease to treat and requires a multidisciplinary and multimodal approach. We discuss the use of a novel approach to counterstrain using irritants - as identified by the patient - to induce symptoms of neuropathy and paresthesia and treat these symptoms as if they were counterstrain tender points. This treatment approach to CRPS has not previously been described in osteopathic manipulative treatment (OMT) literature, including Foundations of Osteopathic Medicine. A 23-year-old female presented with an array of symptoms consistent with complex regional pain syndrome in her right foot and lower leg that had been gradually worsening for approximately one year. She had been treated with physical therapy, medications, injections, orthotics, and a transcutaneous nerve stimulation (TENS) unit, all of which provided temporary symptomatic relief but had not treated the underlying disease. By utilizing the mentioned osteopathic approach to treat the neuropathic aspect of her CRPS, we were able to produce a lasting resolution of her symptoms and improve her loss in proprioception and temperature discrimination in the affected limb. A counterstrain should be considered a reasonable option to assist in the treatment of complex regional pain syndrome. This new treatment approach does not require extensive training or experience with osteopathic manipulative treatment, nor does it take much time to administer. Thus, it could be easily learned and utilized by many standard practitioners for patients with complex regional pain syndrome. In addition, given its low intensity and passive approach, it more likely to be tolerated well by patients. Understanding the challenging nature of treating complex regional pain syndrome, this report aims to be helpful in adding to the general fund of knowledge regarding this condition and the possible treatments. We fully understand that the safety of this intervention cannot be demonstrated with one case nor can the effectiveness. However, our goal is to emphasize and educate readers of these promising results with the hope that this can be the first step toward the required further research in prospective and controlled trials.