Avoiding Pain When Spring Cleaning

It’s spring, and it’s time for spring cleaning! Freshening up your living space can help you get out of winter hibernation, welcome this new season, and boost your mood.

But for people who experience pain on a regular basis, spring cleaning is not easy. Doing chores, moving things around, and even gardening bring risks for injury and worsening of pain.

So how can one prevent injuries and pain during this time of the year? Here are some tips and reminders:

1. Warm up 

Stretching is very important before any activity or exercise, and spring cleaning is no exception. Before you start on cleaning, go for a walk and do some light stretches starting from your neck and work yourself down. Muscles need to be warmed up to help avoid injuries.

2. Plan tasks 

Do not try to finish everything all at once. Instead, make a list and break tasks down into manageable parts. Remember to take frequent breaks to rest and hydrate!

3. Wear the right gear

Be sure to wear comfortable clothing that you can move in. Avoid pants that are too long to avoid tripping, and wear slip-resistant shoes.  Wear protective gear such as goggles, gloves, and masks when working with equipment and cleaning chemicals.

4. Enlist help

Ask someone to help you, especially on lifting and carrying things. Delegate tasks you cannot handle. Maybe you can even make spring cleaning an activity for the whole family!


5. Use tools correctly

Avoid using extra-heavy tools and equipment. Use mops instead of hands and knees for floors and even bathtubs. Keep the vacuum at waist height and use both hands. If you must use a ladder, make sure you use correct ladders for the jobs. Secure the ladder and if possible, have someone be your spotter to hold the ladder.

6. Lift with caution and proper form

As much as possible, avoid lifting heavy things. If you can, divide heavy loads into smaller loads you can handle. Get help with lifting whenever you can. When lifting, always bend at the knees and not your waist and remember to use your legs instead of your back when lifting. Hold heavy items close to your body.

7. Avoid over-reaching, bending, and twisting

Prepare your tools and cleaning supplies ahead of time and keep them within arm’s reach. Avoid over-reaching and extending especially when on a ladder. Avoid twisting movements and instead, move your entire body to face the direction you want to go to.

8. Look out for hazards and clutter

Be careful of wet floors. After mopping floors, take a break in another room and wait while the floor dries. Be cautious when using extension cords, make sure they are secure and not in your way to avoid tripping and falling. Clean up materials after use and avoid placing them in front of walkways or stairs.

9. Be mindful of your problem areas

Know where your painful areas are and be careful when doing activities that use those areas. If you have back pain, be extra careful with lifting and bending. If you have knee pain, use knee pads or cushions if you must kneel. Wear braces for support as needed.


10. Don’t ignore pain

If you start feeling some pain, don’t force yourself. Pain can be a signal that you are doing too much.  Rest, stretch, apply warm or cool compress, or get a massage. If pain persists for a long time or if you have severe pain, see your doctor to be evaluated.

With these tips, preparation, and techniques, we hope you can be able to welcome the season without pain. Happy spring cleaning!

Spine Injection Procedures

Metro spine offers numerous non-surgical interventions aiming to alleviate pain. Some  of the procedures are injections targeting specific parts of the neck and back — Medial branch blocks, transforaminal epidural steroid injections, interlaminar epidural steroid injections, sacroiliac injections, and caudal injections. These are some common Questions and Answers regarding these procedures.

Q: What are these procedures?

A:  These spine interventions are non-surgical procedures which involve injecting numbing and anti-inflammatory medications into the back with the goal of decreasing pain. The procedures vary on the target area and is decided on depending on the patient’s symptoms.

  • MBB (Medial Branch Blocks)  – Also called facet blocks, is a type of injection to the back which targets the medial branches or small nerves in the facet joints (small joints in the spine) at specific levels of the back.  This procedure temporarily interrupts the pain signal being carried by the medial branch nerves that supply a specific facet joint. It may be done to the cervical (neck), thoracic (middle back) or lumbosacral (lower back)regions, depending on the area of pain.
  • TFESI (TransForaminal Epidural Steroid Injection ) – Also called selective nerve root block is a type of injection to the back which targets the area where nerves exit the spine at specific levels of the back to help relieve symptoms of pain. This procedure temporarily interrupts the pain signal being sent from the nerves in the area.
  • ILESI (InterLaminar Epidural Steroid Injection) – a type of injection which targets the nerve roots at specific levels.  At MetroSpine, it is most commonly done to different levels of the neck and upper back depending on the area of pain. This procedure temporarily interrupts the pain signal being sent from the nerves in the area.
  • SI or sacroiliac joint injection – a type of injection which targets sacroiliac joint or the joint between the “tailbone” part of the spine and the pelvis. It may be done on the left and/or right side depending on the area of pain.
  • Caudal Epidural Steroid Injection – Also called caudal block, is a type of injection to the epidural space most commonly done in patient with spinal stenosis or narrowing of the spinal canal. The caudal injection is performed through an opening in the sacrum (commonly referred to as “tailbone”). This procedure temporarily interrupts the pain signal being sent from the nerves in the area.

Q: What happens when I come in for the procedure?

A: Upon getting to the office, you will be asked to sign in and sign consent forms. You will be put in a room where the nurse will talk to you and get your vital signs. If you are getting sedation, the anesthesiologist will come in to discuss the anesthesia procedure and medications. You will then be asked to change into a medical exam gown. You will be brought to the procedure room and asked to lie down on your belly. A fluoroscopy (a type of xray) machine will be brought closer to the table. The physician will clean and drape your back and take images with the xray. After local anesthetic is applied to the area of skin to be entered, a needle is guided into the target area using the fluoroscopy for accuracy and safety. Non-ionic contrast medium is then injected to ensure proper needle placement. After ensuring  proper needle placement, a combination of local anesthetic and corticosteroid is injected into the target area to block the small nerves.

Q: What are the risks or possible side effects with these procedures?


A: Like any procedure involving needles, there is a risk for bleeding and infection. More common side effects include muscle soreness, or bruising. With some of the procedures, temporary weakness of the legs may be experienced after. With any procedure that involves corticosteroids, blood sugar level may be temporarily elevated especially in diabetic patients.

Q:  I am afraid of needles. How can I get the procedure? Will the needles be big?

A: You will not see the needles during the procedure. The needle length will vary depending on the depth from the skin to the spine. An option for patients with anxiety over needles is to undergo the procedure under sedation.

Q: What medications will be injected into my back?

A: The medications commonly used in the MBB are anesthetic (numbing) and antiinflammatory agents. The medications are usually Lidocaine, Bupivacaine, and Depo Medrol ( a type of steroid)

Q: Won’t steroids cause me more harm?

A: The amount of steroid used by the office in the procedure is small, usually at 40 mg. At this dose, and with the intermittent scheduling (we usually do the procedures at intervals of at least one month and not more than 3 of the same procedure in 6 months), the risk brought on by steroid is small compared to the possible benefit of helping manage pain.


Q: What should I expect after the procedure?


A: Right after the injection you may feel that your pain is gone or quite less than prior to the procedure. This is due to the anesthetic. The anesthetic will last for a few hours. The pain may return and you may have a sore back once the anesthetic wears off . You may want to apply ice to the affected area. You should start noticing pain relief 3-5 days after the procedure.


Q: Do I need someone to accompany me for the procedure?

A: As part of our protocol, we do require patients to have a driver for the procedure day. This is to ensure that you will be able to be get home safely after the procedure, since patients respond differently to the injections. With some of the procedures, weakness of the legs may also be experienced and you need someone there for assistance.


Q: I want to know more about this procedure. What resources can I look into regarding this?

A: You may read more about our procedures at our website : https://treatpainmd.com

Also, there are many readings and videos available on the internet about this procedure.  You may use any of the search terms given in the first part of this pamphlet to search for related articles.

Ideas and Tips for Summertime Family Fitness

Children and young adults are recommended to have at least 60 minutes of moderate to vigorous physical activity a day.  It has been found that sedentary children are more likely to experience unhealthy weight gain which can lead to health problems later in life.

Exercising with the family is a good way to start a habit of physical activity with your family. Summer is the perfect time since kids are on a break from school and are excited to do things.

Here are a few things you can do to get the family active this summer:

  • Put on your walking (or running) shoes

Walking is a good introduction to physical activity, and the good thing is it can be done anywhere! For those looking for more vigorous activity, running or jogging is also a good way to enjoy the outdoors with the family. You can go walk or run around the neighborhood or hit the trails at your nearby park. Don’t forget to wear light-colored sweat-wicking clothes and comfortable shoes!

  • Roll on wheels

Brush off the dust from your bikes or skates go for a spin. Biking gets your heart pumping, with less strain on the knees for some. You can also try skating at a nearby skate park or –  for those who want to avoid the heat – an indoor skating rink. Don’t forget the padding and safety gear!

  • Make a splash

What better way to beat the summer heat than to get in the water? Head to the beach or pool and start swimming! Enroll the kids in swimming lessons or join a group water exercise such as water aerobics or water Zumba. Remember to slather on sunscreen and always reapply!

  • Get into the groove


Counties and cities often offer free dance and exercise sessions at the park. Join one and try a new type of dance or look for some free dance lesson trials at a nearby gym. If you prefer to stay away from the crowd, you can also start your own dance party with the kids at home!

  • Team up

Get involved in group sports. Enroll the kids in summer sports camps or classes while you jump and cheer from the sidelines or challenge them to your own team games. Start a game of basketball or flag football with the family. You can even make your own team games or obstacle courses in the backyard.

  • Get to (house)work!

Make a family day out of doing yardwork or gardening by playing music and games. Engage the kids in friendly competition over who gets to finish assigned tasks first. Turn on the water hose and have a splash party in your backyard while watering the plants. Who says chores can’t be fun?


Whichever activity you choose to do this summer, here are some more tips to keep in mind:

Keep hydrated and cool. Drinks lots of water before, during, and after exercising. Avoid the hottest parts of the day (10am to 3 pm). Wear proper clothes and gear. Sport a hat and use sunscreen.

But most importantly, have fun!

Physical Therapy in the Management of Chronic Pain

Physical therapy is a safe and effective alternative to opioid or narcotic medications for management of pain. The question which is often asked is why patients need to go to physical therapy, especially when even the simplest of movements and tasks often causes pain for them. What is the role of physical therapy in treating chronic pain?

Chronic pain patients usually avoid activities that cause pain, which leads to inactivity. In turn, this causes the body to become deconditioned and have reduced strength, range of motion, and endurance. In addition, this also causes the patient to have an unhealthy lifestyle. These changes in turn cause more pain because the body’s weakness and stiffness add stress to the body’s painful areas. Patients also become more susceptible to injury because of weakness.


Physical therapy tackles these problem areas with different modalities to help the body regain strength and conditioning to better handle movement with less stress and thus less pain. It treats pain through exercise, hands-on modalities, and patient education. Physical exercises help strengthen and stretch the body, while manipulation and massage help to ease tightness and help produce pain-relieving chemicals. Patient education promotes confidence and healthy lifestyle for the patient to be able to make changes for the better. The use of other modalities such as hot packs, ultrasound, ice pack, and TENS unit also help in reducing pain.

At Metro Spine, physical therapy is one of the treatment modalities offered, and is usually recommended, for patients who are in pain. If you are interested in doing physical therapy with Metro Spine, please call the office at (301) 856-5860.

Health and Safety Tips for the Holidays

With only a few days to go before the holidays and the coming new year, things can get hectic. Here are some tips to keep yourself healthy, safe, and happy during the holidays:

1. Stay Dry and Warm

Winter is here and aside from freezing temperatures, you may be dealing with snow or hail. Limit your time in the cold and wear appropriate clothing. Dress in light, warm layers, windproof/waterproof coat, gloves/mittens, hats, scarves, and waterproof boots. Check your house heating system to make sure it is running smoothly.

3. Stay Active

It’s easy to forget your regular fitness routine in the midst of all the holiday preparations and celebrations. Try to make sure your workouts are in the morning to complete before other plans later. Avoid prolonged sitting. You can even consider starting a healthy holiday tradition with your family such as a walk, a hike, or physical games.

5. Travel safely

Always follow precautions when walking outdoors. Sprinkle sand or cat litter over icy walkways. Always fasten your seatbelts and buckle children in the appropriate child safety seat. Don’t drink and drive. Don’t let others drink and drive. Pay close attention to weather forecast and road conditions before you travel.


2. Eat Healthy

The holiday season and lots of food seem to go hand-in-hand. Make it easier to stick to healthy eating by moderating your food intake and not forcing yourself to eat everything. Fill your plate with healthier food choices and eat slowly. If you know there will not be a lot of healthy dishes, eat beforehand or bring fruits and vegetables for the party. Keep yourself hydrated by drinking plenty of water.

4. Prevent injuries

Accidents and injuries are common especially during the holidays. Decorating accidents can be avoided by being extra careful in using stepstools and ladders. Keep your house safe from fire by checking your heating system, never leaving fireplaces and candles unattended, and always keeping an eye on your cooking. Install a smoke and carbon monoxide detector and test them regularly. Keep children away from dangerous toys, household hazards, decorations, and fire.

6. Practice food safety

With all the cooking going on, and with all the current food recalls, food safety should all the more be a priority during this holiday season. Wash hands and surfaces often. Avoid cross-contamination by using separate food preparation utensils such as cutting boards and knives, Use a food thermometer and cook foods to proper temperatures. When dealing with leftovers, refrigerate foods promptly and remember safe timelines for keeping leftovers.

7. Prevent the spread of germs

Germs accumulate on your hands throughout the day .Wash your hands regularly and especially after using the bathroom, coughing or sneezing, and handling the garbage. Wash your hands before and after preparing food and eating. Wash your hands with soap and clean running water for at least 20 seconds.

9. Manage stress

Things can get stressful during the holidays with all the celebrations, finishing up for the year, and gearing up for the next year. Take the time to take care of yourself. Give yourself a break between activities especially if you feel stressed out or overwhelmed. Get plenty of sleep. Make sure you find time to maintain your regular relaxation routines.

8. Be smoke-free

Avoid smoking and avoid being exposed to secondhand smoke

10. Get exams and vaccines

Winter season is flu season. Make sure you have your flu shot. Schedule a visit with your health care provider and ask what other vaccinations and tests you should get based on your age, medical history, family history, and lifestyle. You can also take advantage of your free time to call and schedule routine checkup for the coming new year or to look for a doctor if you do not have one yet.

Tips for Exercising in the Cold

The American Heart Association physical activity guidelines recommend at least 150 minutes per week of moderate intensity aerobic activity or 75 minutes per week of vigorous aerobic activity, or a combination of both. However, with the weather still cold, and spring still feeling so far away, it might be difficult for you to think of exercising.  Here are some tips for exercising when it’s cold.

1. Check with your doctor

Always consult your doctor before starting an exercise regimen especially if you have special conditions, such as asthma and heart problems.


2. Check the weather forecast

Consider temperature, wind, and moisture before heading out. Wind and cold extremes can make exercising outdoors unsafe and risky for frostbite.


3. Dress warmly

Make sure to dress in layers of clothing that you can remove and put back on as needed.  Wear clothes with sweat-wicking properties because sweat can lower your body temperature. Make sure to wear a cap, gloves, and thick socks to protect your hands, feet, and ears from frostbite.

4. Warm up properly.

Low temperatures make one prone to injury. Try a mix of stretching and short, simple exercises such as jumping jacks before you start.



5, Keep yourself hydrated

It may be harder to notice dehydration during cold weather. Keep drinking plenty of fluids before, during, and after your workout.


6. Exercise indoors

When the temperature is too low, and with possible ice and snow being a factor, sometimes it is safer to stay home and do your exercises out of the cold. You can do treadmill exercises, skipping, jumprope exercises, or burpees when you’re at home. You can even walk up and down stairs. Remember, it is all about keeping active!


Spinal Stenosis

Spinal Stenosis

Spinal stenosis is the narrowing of the spaces in the spine.

Leave Your Phone Number, Our Experts Will Call You

Our team of board-certified pain relief and physical medicine & rehabilitation specialists use non-invasive, interventional pain management techniques to relieve pain and help you live a healthy, active life.

What are the causes of Spinal Stenosis?

Spinal stenosis typically develops as a person ages and the disks become drier and start to shrink. Disc disease such as herniation can also cause stenosis. The bones and ligaments of the spine can also swell or grow larger due to arthritis or chronic inflammation, as in the case of facet arthropathy.

Other problems, including bone disease such as Paget’s disease, tumors, infection and birth defects, can sometimes cause spinal stenosis.

Symptoms of Spinal Stenosis

Most often, symptoms will be on one side of the body or the other. Symptoms often worsen over time gradually.

Common symptoms of stenosis include numbness, weakness, cramping, pain in the back, buttocks, thighs, or calves; or in the neck, shoulders, or arms depending on location of the stenosis.

Symptoms are more likely to be present or get worse when you stand or walk upright. They will often lessen or disappear when you sit down or lean forward. Most people with spinal stenosis cannot walk for a long period of time. Patients with spinal stenosis may be able to ride a bicycle with little pain.

More serious symptoms include difficulty or imbalance when walking, and problems controlling urine or bowel movements.


The diagnostic process includes:

Medical history. The doctor will ask you questions about your symptoms, their severity, and what treatments you have already tried.

Physical examination. You will be carefully examined for limitations of movement, problems with balance and ambulation, range of motion, and pain. During this exam, the doctor will also look for loss of reflexes, muscle weakness, loss of sensation or other signs of neurological injury.

Diagnostic tests. Most doctors start with x-rays, which allow us to rule out other problems such as tumors and infections. The films also allow us to see if there is any loss of disc space between the vertebrae. In most cases, a Magnetic Resonance Imaging or MRI will be ordered to further evaluate the spine and surrounding structures particularly in diagnosing nerve root compression. In some cases, a test called a discography may be done to confirm the diagnosis. This test involves injecting contrast dye into the affected disc (or discs) to create a clearer image.

Diagnostic tests may be needed to further evaluate the cause and source of symptoms. Tests may include nerve conduction studies and electromyography which will test the nerves and muscles affected; X-ray, Spinal MRI, or spinal CT scan to evaluate the spine and surrounding structures.

Treatment options

Generally, conservative management is encouraged. This involves the use of medications, physical therapy, and lifestyle changes. Steroid injections may relieve pain for a period of time. When your back pain does not go away completely, or it gets more painful at times, learning to take care of your back at home and prevent repeat episodes of your back pain can help you avoid surgery. 

Sacroilliac Joint Dysfunction

Sacroilliac Joint Dysfunction

The sacroiliac (SI) joints are formed by the connection of the sacrum (or “tailbone”) and the right and left iliac bones (commonly known as pelvic bones). As a result, the SI joints connect the spine to the pelvis by a collection of strong ligaments. These joints support the weight of the upper body when we are erect, which places a large amount of stress across them. This can lead to wearing of the cartilage and arthritis.

Leave Your Phone Number, Our Experts Will Call You

Our team of board-certified pain relief and physical medicine & rehabilitation specialists use non-invasive, interventional pain management techniques to relieve pain and help you live a healthy, active life.

What to know about SI dysfunction

There are many different terms for sacroiliac joint problems, including SI joint dysfunction, SI joint syndrome, SI joint strain, and SI joint inflammation. Each of these terms refers to a condition that causes pain in the SI joints from a variety of causes.


There are many different causes of SI joint pain, including pregnancy, limb-length discrepancy or difference in leg length. I some cases, an exact cause leading to a painful SI joint condition cannot be found.

The SI joint, similar to all joints in the body, can be affected by different types of arthritis, including rheumatoid arthritis, gout, and psoriasis. The joint can also be infected in a condition called septic arthritis when bacteria that travel in the blood settle in the joint.

Injury to the SI joint is also thought to be a common cause of pain such as during a fall or a motor vehicle accident.


The most common symptoms from SI joint dysfunction are low back and buttock pain, which may affect one side or both SI joints. The pain can radiate down the leg all the way to the foot or may radiate into the groin area. People often feel muscle spasm in one or both of their buttocks muscles.

Problems with the SI joint may make sitting difficult. Pain in one SI joint may cause a person to sit with that buttock tilted up. It is usually uncomfortable to sit flat in a chair.


Diagnosis begins with a complete history and physical exam to distinguish pain coming from the SI joint from pain coming from other spine conditions. Blood and/or urine workup may be ordered if there is any question whether you might have an infection or some type of arthritis affecting multiple joints. X-rays are commonly ordered of both the low back and pelvis. X-rays of the lumbar spine and hips are helpful to rule out problems in these areas that may act and look like SI joint dysfunction.

Magnetic resonance imaging (MRI) scan can be used to look at the lumbar spine and pelvis in much more detail and to rule out other causing the symptoms. A computed tomography (CAT) scan may also be used to show a much more detailed look at the bone of the pelvis and the sacroiliac joint.

A bone scan is useful to see how the skeleton is reacting to any type of “stress,” such as an injury, an infection, or inflammation from arthritis.

The most accurate way of determining whether the SI joint is causing pain is to perform a diagnostic injection of the joint. Because the joint is so deep, this must be done using X-ray guidance with a fluoroscope (a type of realtime X-ray). Once the doctor places a needle in the joint, an anesthetic is injected into the joint to numb the joint. If your pain goes away while the anesthetic is in the joint, then your doctor can be reasonably sure that the pain you are experiencing is coming from the SI joint.

Failed Back Surgery Syndrome

Failed Back Surgery Syndrome

Failed back surgery syndrome (also called FBSS, failed back syndrome, or postlaminectomy syndrome) is a generalized term that is often used to describe the condition of patients who have not had a successful result with back surgery or spine surgery and have experienced continued pain after surgery.

Leave Your Phone Number, Our Experts Will Call You

Our team of board-certified pain relief and physical medicine & rehabilitation specialists use non-invasive, interventional pain management techniques to relieve pain and help you live a healthy, active life.

What to know about FBSS

Spine surgery can be done to decompress a nerve root that is pinched, or stabilize a painful joint. In some cases, surgery still fails to provide significant relief of pain despite the anatomical changes such as removal of lesions.

Some causes of failed surgery are:

  • Failure of spinal fusion surgery (fusing two or more vertebrae with bone grafts, metal rods and screws), causing problems to another level of the spine above or below the level of fusion
  • Fragment of disc or bone still pinching a nerve
  • Hardware insertion
  • Scar tissue formation
  • Pre-operative nerve damage that does not heal after surgery, or nerve damage occurring during surgery
  • An erroneous initial diagnosis of a patient’s condition
  • Administering improper surgical treatment for the condition
  • Performing surgery at an incorrect level on the spine

Symptoms of failed back syndrome:

  • Continued chronic pain
  • Pain above or below the treated level of the spine
  • Inability to recuperate quickly or at all
  • Restricted mobility and flexibility
  • Sharp, stabbing back pain
  • Pain radiating from the back to the legs
  • Muscle spasms
  • Anxiety and depression
  • Potential dependence on drugs prescribed for pain treatment

Complex Regional Pain Syndrome

Complex Regional Pain Syndrome

Complex regional pain syndrome (CRPS) is a chronic pain condition that can affect any area of the body, but often affects a limb. Complex regional pain syndrome is marked by intense burning or aching pain, as well as swelling, skin discoloration, altered temperature, abnormal sweating and hypersensitivity in the affected area. It is thought that the sympathetic nervous system may play an important role in the pain or possibly by an immune response, which leads to the inflammatory symptoms of redness, warmth, and swelling in the affected area.

Leave Your Phone Number, Our Experts Will Call You

Our team of board-certified pain relief and physical medicine & rehabilitation specialists use non-invasive, interventional pain management techniques to relieve pain and help you live a healthy, active life.

What to know about CRPS

CRPS is thought to result from damage to the nervous system, including the nerves that control the blood vessels and sweat glands. The damaged nerves are no longer able to properly control blood flow, feeling (sensation), and temperature to the affected area.


Complex regional pain syndrome occurs in two types with similar signs and symptoms, but different causes:

  • Type 1. Previously known as reflex sympathetic dystrophy syndrome. This type occurs after an illness or injury that did not directly damage the nerves in the affected limb. About 90 percent of people with complex regional pain syndrome have type 1.

  • Type 2. Previously referred to as causalgia, this type follows a distinct nerve injury.

Many cases of complex regional pain syndrome occur after a forceful trauma to an arm or a leg, such as a gunshot wound or shrapnel blast. Other major and minor traumas such as infections, surgeries, fractures, or sprains can also lead to complex regional pain syndrome.


The main symptom of complex regional pain syndrome is intense pain, which gets worse over time. Additional signs and symptoms include:

  • “Burning” pain in your arm, leg, hand or foot.
  • Skin sensitivity.
  • Changes in skin temperature – At times may be sweaty; at other times it may be cold.
  • Changes in skin color – can range from white and mottled to red or blue.
  • Changes in skin – may become tender, thin or shiny in the affected area.
  • Changes in hair and nail growth.
  • Joint stiffness, swelling and damage.
  • Muscle spasms, weakness, and loss (atrophy).
  • Decreased ability to move the affected body part.


Diagnosis of complex regional pain syndrome is based on a physical exam and your medical history. There is no single test that can definitively diagnose complex regional pain syndrome, but the following procedures may provide important clues:

  • Bone scan: A radioactive substance injected into one of your veins permits viewing of your bones with a special camera. This procedure may show increased circulation to the joints in the affected area.
  • Sympathetic nervous system tests: These tests look for disturbances in your sympathetic nervous system. For example, thermography measures the skin temperature and blood flow of your affected and unaffected limbs. Other tests can measure the amount of sweat on both limbs. Dissimilar results can indicate complex regional pain syndrome.
  • X-rays: Loss of minerals from your bones may show up on an X-ray in later stages of the disease.
  • Magnetic resonance imaging (MRI): Images captured by an MRI device may show a number of tissue changes.


There is no cure for CRPS. Instead, treatment is aimed at alleviating painful symptoms. The following therapies are often used:

Physical therapy: A gradually increasing exercise program to keep the painful limb or body part moving may help restore some range of motion and function.

Psychotherapy: CRPS often has profound psychological effects on people and their families. Those with CRPS may suffer from depression, anxiety, or post-traumatic stress disorder, all of which heighten the perception of pain and make rehabilitation efforts more difficult.

Sympathetic nerve block: Some patients will get significant pain relief from sympathetic nerve blocks. Sympathetic blocks can be done in a variety of ways. One technique involves intravenous administration of phentolamine, a drug that blocks sympathetic receptors. Another technique involves placement of an anesthetic next to the spine to directly block the sympathetic nerves.

Medications: Many different classes of medication are used to treat CRPS, including topical analgesic drugs that act locally on painful nerves, skin, and muscles; antiseizure drugs; antidepressants, corticosteroids, and opioids. However, no single drug or combination of drugs has produced consistent long-lasting improvement in symptoms.

Surgical sympathectomy: The use of surgical sympathectomy, a technique that destroys the nerves involved in CRPS, is controversial. Some experts think it is unwarranted and makes CRPS worse; others report a favorable outcome. Sympathectomy should be used only in patients whose pain is dramatically relieved (although temporarily) by selective sympathetic blocks.

Spinal cord stimulation: The placement of stimulating electrodes next to the spinal cord provides a pleasant tingling sensation in the painful area. This technique appears to help many patients with their pain.

Intrathecal drug pumps: These devices administer drugs directly to the spinal fluid, so that opioids and local anesthetic agents can be delivered to pain-signaling targets in the spinal cord at doses far lower than those required for oral administration. This technique decreases side effects and increases drug effectiveness.