Treating Complex Regional Pain Syndrome: A Primary Care Primer
Complex regional pain syndrome (CRPS) has proven very difficult to treat successfully, despite research into a wide variety of pharmacologic and nonpharmacologic therapies.1,2 The earlier the diagnosis is made and treatment is begun, the greater the likelihood of at least lessening, if not completely eliminating symptoms, and of long-term recovery.
Although none of the therapies have proven to be especially effective for most patients with CRPS, they may be worth trying as each may provide some benefit for the individual patient. In the slides below, find a primer on which therapies have been found beneficial for patients with CRPS.
To find out more about diagnosing CRPS, check out Diagnosing Complex Regional Pain Syndrome: A Primary Care Primer.
Among the medications that have been studied for CRPS and might provide some benefit for certain patients are medications for neuropathic pain, vasodilators, and muscle relaxants.
Opioids have not been found to be widely efficacious for CRPS. While there may be some patients who do obtain pain relief from opioids, an opioid trial should only occur after the medications that are more likely to be beneficial are tried.
Use of the affected limb can be painful, so physical and occupational therapies may be beneficial to at least prevent problems stemming from disuse and to reduce the risk of the development of pain elsewhere in the body.
Acupuncture and transcutaneous electrical nerve stimulation may also provide benefit with little risk of adverse events. It is worth noting, however, that some patients with allodynia may not be able to tolerate either modality.
Patients may oppose referrals for psychological treatments because they fear that the pain is not being taken seriously by their health care provider, but the interventions can help them cope with the pain and other symptoms, as well as prevent them from becoming dysfunctional.
Sympathetic nerve blocks have not demonstrated benefits in CRPS and are not currently recommended, especially if the diagnosis is not made within the first few weeks of the onset of symptoms.
Some studies have indicated that spinal cord stimulation may be beneficial for some patients; however, currently there are no factors that allow prediction of which patients may benefit and further studies are needed before it can be recommended.
Because spontaneous resolution of CRPS can occur even several years after the onset of symptoms, it is important for clinicians to tell patients that they should not give up hope of this occurring.
References:
1. Atkinson L, Vile A. Unravelling the complex regional pain syndrome enigma. Pain Med. 2020;21:225-229.
2. Bharwani KD, Dirckx M, Huygen FJPM. Complex regional pain syndrome: diagnosis and treatment. BJA Education. 2017;17:262-268.
