From the Guidelines
Treatment for Complex Regional Pain Syndrome (CRPS) flare-ups should prioritize an early course of oral corticosteroids, starting at 30–50 mg daily for 3–5 days, and then tapering doses over 1–2 weeks to reduce swelling and pain. This approach is supported by the highest quality evidence available, which suggests that corticosteroids can be effective in managing CRPS symptoms 1.
Key Considerations for CRPS Management
- The use of a triple phase bone scan can assist in diagnosis by demonstrating increased periarticular uptake in distal upper extremity joints 1.
- Management strategies should aim to reduce pain and swelling, with oral corticosteroids being a recommended initial treatment.
- It is essential to monitor patients closely and adjust treatment plans as needed to minimize potential side effects and maximize symptom relief.
Additional Management Strategies
- While the primary recommended treatment is oral corticosteroids, other management strategies may include physical interventions and self-management techniques to help manage symptoms and improve quality of life.
- However, the most recent and highest quality evidence prioritizes the use of oral corticosteroids as the initial treatment for CRPS flare-ups 1.
Prioritizing Evidence-Based Practice
- In clinical practice, it is crucial to prioritize the most recent and highest quality evidence when making treatment decisions.
- The recommendation for oral corticosteroids is based on the strongest available evidence 1, and this approach should be prioritized in the management of CRPS flare-ups.
From the Research
Treatments for Complex Regional Pain Syndrome (CRPS) Flare-ups
- Pharmacological management:
- Gabapentinoids, bisphosphonates, ketamine, and pulsed dose steroids have at least modest evidence for their use in CRPS treatment 2
- Tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SNRIs) are also commonly prescribed, although they lack significant evidence specifically in CRPS 2
- Interventional modalities:
- Sympathetic nerve blocks (stellate ganglion and lumbar sympathetic) are first-line interventional treatment options for patients with CRPS of the upper and lower extremities, respectively 3
- Novel neuromodulation therapies, such as dorsal column stimulation and dorsal root ganglion stimulation, have been developed to treat CRPS 3
- Alternative therapies:
- Scrambler Therapy(®) (ST) has been found effective in patients with CRPS, providing pain relief and improving quality of life 4
- Systemic intravenous lidocaine has been used to treat CRPS, although its use is not well-documented 5
- Somatic and abdominal acupuncture may be a potential alternative for pain treatment in adolescent CRPS patients, especially when conservative therapy fails 6
- Multidisciplinary approach:
- CRPS treatment often requires a combination of medication, physical therapy, occupational therapy, psychological therapy, and interventional procedures to restore the patient's quality of life 3