From the Guidelines
Complex Regional Pain Syndrome (CRPS) treatment should prioritize a multidisciplinary approach, focusing on medications, physical therapy, and psychological support, with an emphasis on early intervention to improve outcomes. The treatment of CRPS requires a comprehensive strategy that addresses the complex interplay of pain, inflammation, and psychological factors.
Medications
- Pregabalin is suggested for the treatment of pain in patients with CRPS 1, as it has been shown to be effective in managing chronic pain.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are not recommended for the treatment of chronic pain related to CRPS 1, due to their limited efficacy and potential side effects.
- Serotonin-norepinephrine reuptake inhibitors may be considered for the treatment of pain and improved functional status in patients with CRPS 1.
Physical Therapy
- Physical exercise is suggested for patients with CRPS 1, as it can help improve functional status and reduce pain.
- Manual acupuncture may be considered as part of the management of patients with CRPS 1, as it has been shown to be effective in reducing pain and improving quality of life.
Psychological Support
- Cognitive-behavioral therapy is suggested for patients with CRPS 1, as it can help patients develop pain management strategies and improve their quality of life.
- Mindfulness-based therapies may be considered for patients with CRPS 1, as they can help reduce stress and improve pain management.
Other Interventions
- Sympathetic nerve blocks, spinal cord stimulation, or intrathecal drug delivery systems may be considered for severe cases of CRPS, although the evidence for these interventions is limited 1.
- Early rehabilitation is crucial in the management of CRPS, and treatment should be individualized to address the specific needs of each patient 1.
From the Research
Treatment Options for Complex Regional Pain Syndrome (CRPS)
The treatment options for CRPS can be categorized into several approaches, including:
- Physical therapy: considered the cornerstone and first-line treatment for CRPS, especially for mild cases 2
- Pharmacological management: includes the use of adjuvant analgesics, such as anticonvulsants and/or antidepressants, as well as opioids for moderate to severe pain 2, 3
- Interventional modalities: sympathetic nerve blocks, spinal cord stimulation, and dorsal root ganglion stimulation are options for patients who do not respond to conservative treatment 4, 5, 6
- Multidisciplinary approach: a combination of medical, psychologic, physical, and occupational therapy is often necessary for optimal management of CRPS 2, 4, 3
Specific Treatment Modalities
Some specific treatment modalities for CRPS include:
- Sympathetic nerve blocks: can be used to assess and treat sympathetically maintained pain 4, 6
- Spinal cord stimulation: has been shown to be effective in reducing pain and improving quality of life in patients with CRPS 5
- Gabapentinoids, bisphosphonates, ketamine, and pulsed dose steroids: are commonly used pharmacologic agents for CRPS, although evidence for their efficacy is limited 3
- Tricyclic antidepressants and selective serotonin reuptake inhibitors: are also used to treat CRPS, although their evidence is primarily based on other neuropathic conditions 3
Goals of Treatment
The primary goals of CRPS treatment include:
- Pain relief
- Functional restoration
- Psychological stabilization
- Early intervention is crucial to achieve these objectives 5