From the Research
Reflex Sympathetic Dystrophy (RSD), now more commonly known as Complex Regional Pain Syndrome (CRPS), should be treated with NSAIDs like ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for mild cases, as they are slightly more effective in short-term reduction of pain intensity and disability compared to placebo, as shown in a recent study 1. The treatment of RSD/CRPS often targets the inflammatory component, which is characterized by elevated levels of pro-inflammatory cytokines such as interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and interleukin-1 beta (IL-1β) in affected tissues and sometimes systemically. Some key points to consider in the treatment of RSD/CRPS include:
- The use of NSAIDs, which have been shown to be effective in reducing pain and disability in the short-term, but may have cardiovascular risks, particularly with long-term use or in high doses, as highlighted in a study on the cardiovascular risks of NSAIDs 2.
- The potential benefits of corticosteroids, such as prednisone, for moderate to severe cases, which can help reduce inflammation and pain, but should be used with caution due to potential side effects.
- The importance of physical therapy in maintaining function and reducing pain, as well as the potential benefits of bisphosphonates, such as alendronate, in reducing bone changes associated with RSD/CRPS.
- The need to interpret elevated inflammatory markers, such as CRP and ESR, with caution in obese patients, as they may be falsely elevated due to obesity rather than disease activity, as shown in a study on the impact of obesity on inflammatory markers in rheumatoid arthritis 3. It is essential to weigh the benefits and risks of each treatment option and to consider the individual patient's needs and circumstances when developing a treatment plan for RSD/CRPS. Additionally, the use of gabapentin or pregabalin for neuropathic pain, and the potential benefits of early aggressive treatment in reducing the risk of central sensitization and chronic pain, should also be considered, as highlighted in a study on the treatment of acute pain 4. Overall, a comprehensive treatment plan that addresses the inflammatory, neuropathic, and functional components of RSD/CRPS is crucial in managing this complex condition.