CRPS, or Complex Regional Pain Syndrome (Type 1), is a change in the nervous system that's usually triggered by a very painful episode. The bad kinds affect the brain, nerves, muscles, skin, metabolism, circulation, and fight-or-flight response. Lucky me; that's what I've got. ... But life is still inherently good (or I don't know when to quit; either way) and, good or not, life still goes on.

Sunday, November 11, 2012

The sheer activity of Epsom salt baths

Taking a day to rest has been just the thing.

Now here's what I mean when I say, "I took an Epsom bath..." And I'm sorry to say that getting images loaded will have to wait for another day, so use your imaginations for now :-)

Nearly all motels have a bathtub. I consider this essential. They're small, but adequate. With a swipe of cleanser and a quick rinse, I've found all of them usable so far.

Temperature – the first consideration

People with chronic CRPS have two substantial issues that affect bath temperature: wonky signals to the circulatory system, and screwy temperature regulation.

Hot baths are a thing of the past. They aren't good any more.

I like a bath that's just a few degrees warmer than the temperature that feels like nothing on your skin. That seems to provide the best results.

I find chlorine to be counterproductive, so I let it go first. I run the tub a little hot, with the fan on, and leave the room for 5 minutes until most of the chlorine dissipates. Then I adjust the temperature.

MgSO4, my ally

I've gone up to using about 2 pounds of Epsom salt for one bath. That's about a third of the 6 pound bag, costing between $3.50 and $6.50, depending on where you buy them. I used to use a cup or two, but I really get better results with a stronger solution.

The process

Remember, this is about re-regulating and re-normalizing, so leaping into the bath and getting busy is the wrong thing to do. Going one step at a time and persuading my body to stabilize at each point is how the process works.

So I take a couple minutes to just sink into it, let the mottling pattern on my lower body and arms fade, and get some circulation going to my overworked skin. I brush over all my limbs with my hands, introducing them to the idea of tactile input, and how that should go.
Nearly all motels have washcloths with a nice scrubby texture.
The soft kind that you get in the bath and body store feels to me like turgid gelatin, soaking up a lot of soap and doing very little in the way the exfoliation – which is what I used to use washcloths for.

Now, it's all about renormalization – or, to use the standard allopathic medical term, desensitization. (Leave it to medicine to make returning to normal sound like something bad!)

I start with the soles of my feet. I hold the washcloth in my open hand, using a big, squishing gesture.
With that big gesture, and a certain amount of gentle elbow grease, I reassure the soles of my feet that they're doing fine. Once they start sending appropriate signals of touch and motion, I work around the foot and up my ankles.

Using the washcloth in one hand, and nothing in the other, I alternate strokes, soothing the frazzled burning sensation left by the terrycloth with the silkiness of Epsom water in my palm. I don't just notice what the sensations are from my skin, I tell that part of me what the sensations ought to be: It's just terrycloth. There's no burning here. It's just terrycloth. It should feel pleasantly scrubby, nothing more.

Every now and then, I move the washcloth to a part of my body that still thinks terrycloth is just terrycloth, and give it a brief demonstration. That seems to help.

My calves take a little extra care. I always start on the left, and it feels like a hunk of plastic. I tell it to calm down – in firm, maternal yet authoritarian tones – and go squish my right calf instead. When my right calf and shin are sending nice, normal signals of terrycloth texture in motion, I go back to my left calf, reassuring it that you can be normal, you know perfectly well what that feels like, there you go, you can do it.
This is a sidebar note, but it's relevant… When I was studying up on Dr. S. V. Ramachandran's work on mirror therapy and lens therapy for people with amputations and other limb pain problems, what impressed me most was the plasticity of the brain. With enough persistence, and a persuasive enough message, the brain can be reshaped.
Since so much of CRPS's maintenance relates to the brain having been reshaped in a distorted way, part of the task is to reshape it into a healthier structure.
There are several ways to do this, including lenses (optical input is very powerful in the brain) and forms of retraining, such as meditation – and the exertion of parental authority over your own being.

Speaking to my body in tones of loving maternal authority, I find, is remarkably persuasive.
Eventually, my left calf loses that awful dense feeling and starts to feel like a leg again. Then I coach it not to send sparkling messages of hot and cold where the washcloth goes, but just the sensation of terrycloth rubbing moderately over skin, and that that's okay and the right thing to do.

In mobilizing tissue, the washcloth provides traction against my skin, so I hardly have to use any hand strength at all. This is important, because if I had to rely on my grip to get hold of the tissues, this would be totally out of the question. The water neutralizes a lot of gravity, so it's easier to control a limb you're massaging.

I can squish the muscles with one hand or two, bouf them against the bone, and jostle them around. You can mobilize quite a lot of tissue with very little effort, if you use a washcloth in the bath.

I work my way up my legs, paying attention to the major nerve path and the major muscle groups (always with big, squishy gestures, not too challenging, but mobilizing.) I go back to my knees a couple of times, where the main issue is to mobilize the circulation and draw away the swelling.

I work on my low back and hips until the inclination to spasm turns off. I tell them to take it easy, just let go, you'll know when it's time to contract, now settle down.
Then I lean forward to dip my arms and work on them, with somewhat gentler gestures. Since I can't remember just what normal sensation is there, I look for overall warmth and better mobility in my forearms, with touch signals as close to normal as we can get.
Part of the idea, obviously, is not only to re-normalize my skin as much as possible, but to improve surface circulation, so that as much magnesium as possible can be taken up by the troubled tissues.

Once I have squishy-massaged my arms from fingertips to collarbones, I do a quick scrubby pass on my back (where I used to get symptoms, and don't want anymore)…

And then I get the Calgon experience, lying back in a warm bath, feeling alive and remarkably well, with nothing to do but enjoy myself until the water cools.
I figure I should spend at least a solid 20 min. in the tub, to absorb as much as possible of the magnesium, the warmth, and the chance to melt all the little knots out of my brain.

It's not a bad prescription. Not bad at all. There is always considerable improvement, and sometimes it makes me feel almost completely well.


  1. Well, you just made me ask for help to fill the bath! Being sensitive to sulfur compounds, epsom salts is out for me, but I am having discussions with my chemical company about affordable, reliably pure magnesium chloride... hoping it will work out as a wonderful substitute. Magnesium chloride hexahydrate is currently used as "magnesium oil" or topical solution and is a wonderful spasm and pain reducing product, so here's hoping my powdered mag chlor will help me to "Calgonland" as well. Great article as always!

    1. Thank you, and I'm delighted to take credit for getting you into a nice bath :)

      It would be wonderful if you posted a follow-up comment about the MgClH6 (did I get that right?) and let us know who your supplier is. That could be very helpful to others, especially if it absorbs better than the MgSO4.

  2. t a wonderful write up on this subject, I would only add a bit about after the bath Isy, I notice that the epsome salts and warm water really open up the pores and dialate the blood vessels, this can lead to inflammation when/if one gets up and walks around too soon afterwards, I like to recomend a person rest with legs elevated for @ 10 minutes afterwards to regulate pressure before resuming activitys.

    1. Thank you!

      Sandy raises an excellent point, which I had forgotten about by the time I finished the article… Even a tepid to warm bath causes the peripheral vessels to open up, and we have to be aware of the state of our vessels, since a dysautonomic nervous system can't compensate for changes in posture and position.

      My usual approach is to empty the bath while I'm in it. This reintroduces my body to gravity and air gradually enough that I'm generally asymptomatic when I get out. I think Sandy's suggestion is probably more comfortable for many people, though.

      Before I came to terms with tepid baths, and always made the water too warm, I had to lie straight down – sometimes on the bathroom floor – for at least 20 min. afterwards. Otherwise, the nausea and disorientation was intolerable.


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