How do you Treat Complex Regional PainSyndrome?
The ‘four'pillars' of CRPS therapy include patient education, alleviation of pain, physicalrehabilitation and psychological help, in order to improve the quality oflife of the patient.
Patient education
Patients should be explained the natureof their condition, the fact that it is chronic and there is no cure. Based onthe severity of symptoms and their needs, patients should be urged to settreatment goals and follow a pace that is comfortable to them.
PainMedications
No medications are specifically approved for use in CRPS
- Treatment for mild CRPS is with simple analgesics such as non-steroidal anti-inflammatory drugs (NSAIDs), adjusting the dose so that the patient is able to use the limb and perform gentle exercises
- If pain is moderate to severe or does not respond to simple measures by 3-4 weeks then use tricyclic antidepressants or gabapentin may be considered
- During occasional flare-ups that are normal, medications should be continued with a temporary decrease in intensity of physical exercise
- Medications for associated depression if present
- Bisphosphonates- Some patients with CRPS have evidence of bone loss that is very painful. Preventing bone loss in such cases may reduce bony pain.Pamidronate can be tried in patients with CRPS of less than six months duration. Other bisphosphonates have also been found to be effective in reducing pain
- Baclofen may be helpful if there is associated muscle spasm.
Physical rehabilitation
Physical therapy plays an important rolein treatment and is advised in all cases. It should be initiated early, after adiagnosis has been made. Strategies include limb exercises aiming to gainbetter postural control and load bearing of the limb.
PsychologicalSupport
- Psychological support including cognitive behavioral therapy, relaxation techniques, counseling alongside medications and physical and occupational therapy, can be particularly beneficial in CRPS.
- Psychological evaluation by an expert in chronic pain may be necessary in some patients to identify factors causing poor patient response
MiscellaneousMeasures
Blockage of sympathetic nerve may relieve intractable pain in some cases
- Nerve stimulation with electrical or magnetic currents or implanting a device
- Clonidine injection into the spinal space
- Cutting or clamping the sympathetic nerve chain may offer relief from chronic pain
