Recent evidence of treatment of Complex Regional Pain Syndrome
rational approach to the treatment of Complex Regional Pain Syndrome (∗ denotes stronger recent evidence)
- • Stimulation of inhibitory neurons
- – Spinal cord stimulation∗
- • Physical therapy (PT)∗
- – Massage, counterirritants
- – Ultrasound
- – Electroacupuncture
- – Transcutaneous nerve stimulators
- • Antiinflammatory agents
- – Nonsteroidal antiinflammatory drugs (NSAIDs)
- – Ketorolac in an intravenous (IV) regional block
- – Corticosteroids∗
- • Sympathetic blocks
- – Lidocaine, mepivacaine, bupivacaine, etc., into sympathetic ganglion
- – Bier block with IV guanethidine, bretylium, reserpine (depletes norepinephrine) (not very effective and rarely used)
- – Oral β-blockers (not very effective)
- – Prazosin, phenoxybenzamine, terazosin (α-1 adrenergic blockers)
- – IV phentolamine (α-1 adrenergic blocker)
- – Oral, patch, or epidural clonidine
- – Sympathectomy (surgical)
- – Injection of opioid into sympathetic ganglion
- • Depletion of substance P in peripheral nerves
- – Topical capsaicin
- • Anticonvulsants
- – Phenytoin
- – Carbamazepine
- – Gabapentin and pregabalin
- – Valproic acid
- • Antiosteoporotic therapy
- – Calcitonin∗
- – IV bisphosphonates (pamidronate 1 mg/kg)∗
- – High dose (40 mg/day) or normal dose (70 mg/week) oral alendronate
- • Treatment of dystonia
- – Intrathecal baclofen (GABA agonist)
- – Local botulinum toxin injections
- • Other treatments
- – IV lidocaine and 5% lidoderm patches (sodium channel blocking agents)
- – IV ketamine (block NMDA receptor)∗
- – Stop ACE inhibitors
- – Tricyclic antidepressants and serotonin and norepinephrine reuptake inhibitors
- – Calcium channel blockers
- – Dimethyl sulfoxide topically
- – Topical lidocaine
- – Repetitive transcranial magnetic stimulation (in trials)
- • Psychological therapy
- – Establish rapport with the patient, provide emotional support, assess for depression, and treat with psychotherapy and medications if a problem
- – Thermal biofeedback, relaxation training, alcohol and tobacco cessation
- – Cognitive behavioral therapy∗.
