This book describes an accident in which the author suffered three severe crush fractures to the metacarpal bones of her right hand and which led to her developing complex regional pain syndrome (CRPS). It goes on to detail the treatments and management strategies she explored, including NHS medical care with occupational therapy (hand therapy), acupuncture, Alexander Technique, collateral meridian therapy, osteopathy, massage, wax baths, mirror therapy, pain meditation, nutritional advice, and herbal remedies.

The author was unlucky enough to encounter medical professionals who were not familiar with CRPS. The condition is also known as reflex sympathetic dystrophy (CRPS type 1) and causalgia (CRPS type 2) – names by which most doctors would know the condition, despite the author's irritating sweeping statement in the Introduction: "Very few of the medical profession had heard of CRPS." It is a form of neuropathic pain, i.e. it is due to physical damage to nerves. The pain is completely out of proportion to the levels expected from the fractures sustained: discoloured and mottled skin with rapid temperature changes, an extreme sensitivity to stimuli (e.g. a breeze over the affected area, even sound vibrations), muscle spasm, oedema, overgrowth of thicker, darker hair in the affected area, abnormalities in the nails, etc.

There is a reprint of a document from the Pain Relief Foundation which describes the condition in great detail and is a very useful resource, and an interesting description of phantom limb pain. The reader is mining a rich seam of extremely useful tips (far too many to list) for the day-to-day management of this condition. Brief descriptions of all the therapies and techniques and the way in which they were conceived with the idea of healing the whole person are included, as well as a contact section with details of relevant organisations. The founders of the various disciplines are profiled, including a four-page item about Alexander and the Technique. There is a useful associated website with links to all the associations including STAT. A biography of the author herself would have been interesting.

The writing style is informal, narrative and an easy read for a lay person. The intended audience is patients and health professionals who are not familiar with CRPS. I consider it a ‘must read’ for Alexander teachers who have a pupil or friend with the condition, and a valuable addition to the literature on the subject.

The text is accompanied by clear and useful illustrations including X-rays, drawings of the hand from Gray’s Anatomy, photographs to demonstrate exercises and activities, and the author's hand-drawn cartoons showing her various suggestions for practical ways to alleviate pain (see above).

Because she was worried about the fact that her posture was suffering as a result of the antalgic (pain-avoidant) position she had to adopt during her waking and sleeping hours, she decided to take some Alexander lessons which, unfortunately, she refers to as a treatment. She had had lessons 12 years previously and about once a year thereafter if she had hurt her back, for example by sitting badly in front of the computer or lifting something heavy.

The conclusion of this book is that CRPS is most successfully treated with a multi-disciplinary approach. The author is complimentary about the Alexander Technique and about the complementary roles the various therapeutic methods had in securing her recovery from this horrible condition. If ever I am unfortunate enough to suffer from CRPS, I will be reaching (with the other hand) for this book.

© Dr Miriam Wohl 2011