From the Research
Treatment of allodynia in complex regional pain syndrome (CRPS) requires a multimodal approach combining medications, physical therapy, and interventional procedures, with a focus on reducing central sensitization and interrupting the pain cycle, as supported by the most recent and highest quality study 1. The management of CRPS is challenging due to its complex pathophysiology, which involves neuropathic inflammation, autonomic nervous system dysfunction, and potential genetic and psychological factors 1. Key treatment options include:
- First-line medications: anticonvulsants such as gabapentin or pregabalin, tricyclic antidepressants like amitriptyline, or SNRIs such as duloxetine 1, 2, 3
- Topical treatments: lidocaine patches or capsaicin cream for localized relief 1
- Physical therapy: desensitization techniques, mirror therapy, and graded motor imagery to retrain the brain's pain processing 1, 4
- Psychological approaches: cognitive behavioral therapy to develop pain coping strategies 1, 3
- Interventional procedures: sympathetic nerve blocks, spinal cord stimulation, or intrathecal drug delivery for refractory cases 1, 4 It is essential to note that early treatment is crucial, as allodynia becomes more difficult to manage the longer CRPS persists, and the goal is to reduce central sensitization and interrupt the pain cycle 1. The most recent study 1 provides the strongest evidence for the treatment of allodynia in CRPS, and its recommendations should be prioritized in clinical practice.