From the Guidelines
Complex Regional Pain Syndrome (CRPS) treatment should prioritize a multidisciplinary approach, including medications, physical therapy, and psychological support, with oral corticosteroids as a potential treatment option, as suggested by the Canadian stroke best practice recommendations update 2015 1. The treatment of CRPS involves a combination of pharmacological and non-pharmacological interventions.
- Medications may include nonsteroidal anti-inflammatory drugs (NSAIDs), anticonvulsants, and antidepressants, although the provided evidence does not specify these treatments for CRPS.
- Physical therapy is essential and should focus on gentle movement and desensitization techniques.
- Psychological interventions, such as cognitive behavioral therapy, can help manage the emotional aspects of chronic pain. The provided evidence from the Canadian stroke best practice recommendations update 2015 1 clarifies the starting doses and treatment scheduling for oral corticosteroids in CRPS treatment, highlighting the importance of individualized treatment approaches. In terms of specific treatment options, the evidence does not provide detailed information on medications such as gabapentin, pregabalin, or amitriptyline, which are commonly used in CRPS treatment. However, the use of oral corticosteroids, as mentioned in the Canadian stroke best practice recommendations update 2015 1, should be considered as a potential treatment option for CRPS, taking into account the individual patient's needs and response to treatment. It is essential to note that the treatment of CRPS should be tailored to the individual patient, and a multidisciplinary approach is crucial for achieving better outcomes.
From the Research
Treatment Options for Complex Regional Pain Syndrome (CRPS)
The treatment of CRPS often requires a multidisciplinary approach, including:
- Medication
- Physical therapy
- Occupational therapy
- Psychological therapy
Interventional procedures 2, 3, 4, 5, 6
Interventional Treatments
Interventional treatments for CRPS include:
- Sympathetic nerve blocks (stellate ganglion and lumbar sympathetic) as first-line treatment options for patients with CRPS of the upper and lower extremities, respectively 2
- Novel neuromodulation therapies, such as dorsal column stimulation and dorsal root ganglion stimulation 2
- Sympathectomy, with some studies showing transient benefit and others showing no beneficial effects 6
- Spinal cord stimulation, with studies showing a potential beneficial effect in pain reduction 6
Non-Interventional Treatments
Non-interventional treatments for CRPS include:
- Physical therapy, with the goal of gradual, persistent, functional improvement 3
- Occupational therapy, which is an essential part of multimodal therapy for CRPS, with goals and methods varying greatly depending on the symptomatology 4
- Psychological therapies, such as biofeedback, cognitive-behavioral techniques, and relaxation training with biofeedback, to address psychosocial and behavioral aspects of CRPS 3, 5
- Medications, such as bisphosphonates, calcitonin, local anesthetics, calcium channel blockers, anticonvulsants, and alpha-adrenergic antagonists, to target various pathophysiologic mechanisms 3, 6
Multidisciplinary Approach
A multidisciplinary approach to management, including medical, psychologic, physical, and occupational therapy, is essential for effective treatment of CRPS 2, 3, 4, 5, 6