Treatment for CRPS
There is no cure for CRPS. The goals of treatment are to relieve painful symptoms and maintain as much mobilization of the affected limb as possible so people with the disorder can resume their normal lives. CRPS treatment involves an individualized treatment plan, which often combines several therapies, including the following:
Medication to Treat RSD/CRPS
Treatment for CRPS involves medications to control pain. However, at this time, no single drug or combination of medicines has produced consistent, long-lasting symptom improvement. The type of medication prescribed is determined by the type of pain experienced by the patient.
Constant pain caused by inflammation is treated using nonsteroidal anti-inflammatory drugs (NSAIDs; e.g., aspirin, ibuprofen, naproxen, indomethacin). Due to potenially severe gastrointestinal and cardiovascular side effects, NSAIDs should only be used as instructed.
Constant pain not caused by inflammation may be treated with central acting agents, such as tramadol (Ultram®).
Sharp pain and pain that disrupts sleep may be treated with antidepressants (e.g., amitriptyline, doxepin, nortriptyline, trazodone) or anticonvulsants (e.g., carbamazapine, pregabalin).
In some cases, generalized, severe pain that does not respond to other medications may be treated with opioids (e.g., propoxyphine, codeine, morphine).
Muscle cramps (spasms and dystonia) can be treated using clonazepam and baclofen.
Localized pain related to nerve injury may be treated with Capsaicin® cream, but the effectiveness of this medication to treat RSD/CRPS has not been proven.
Medications that affect the sympathetic nervous system such as clonidine (Catapres®) also may be useful in some cases.
Muscle stiffness may be treated with muscle relaxants such as
- Tizanidine (Zanaflex®)
- Clonazepam (Klonopin®)
Physical Therapy to Treat RSD/CRPS
Physical therapy for RSD/CRPS involves daily range of motion exercises. Patients are advised to avoid activities that could accelerate osteoporosis or cause joint injury.
Nerve Block to Treat CRPS
Sympathetic nerve block interrupts the transmission of pain signals from a group of nerve cell bodies (called a ganglion). Nerve block should be performed by a physician who is familiar with the procedurethere are several techniques available. One method involves inserting a needle into the appropriate location (e.g., alongside the windpipe [trachea], in the lower [lumbar] spine) and injecting an alpha adrenergic antagonist (type of anesthesia) into the ganglion. When treating an upper extremity, the procedure is called a stellate ganglion block.<> The effects of sympathetic nerve block are monitored over time. Some people with CRPS get significant pain relief from this treatment.
Surgical Sympathectomy to Treat RSD/CRPS
CRPS patients who have a good but temporary response to nerve block may be candidates for a surgical procedure called sympathectomy. This procedure involves cutting and sealing (cauterizing) a portion of the sympathetic nerve, which runs down the spine. The goal of treatment is to suppress sympathetic nervous system activity in the affected area. The role of sympathectomy to treat CRPS is controversial and in some cases, the procedure worsens symptoms.
Spinal Cord Stimulation to Treat RSD/CRPS
A transcutaneous electrical nerve stimulation (TENS) unit may be used to treat the affected area in patients who have CRPS. In some cases, a spinal cord stimulator is permanently implanted. This device supplies low-intensity impulses to a location in the spinal cord to interrupt the pain signals that are being transmitted to the brain. This treatment helps relieve pain for some patientscausing a tingling sensation in the affected area.
Psychotherapy for RSD/CRPS
RSD/CRPS patients often become depressed and anxious because of chronic pain and reduced physical ability. Counseling, support groups, and chronic pain center programs can help patients learn coping strategies and can provide emotional and psychological support.
Physical Therapy to Treat RSD/CRPS
People with CRPS may benefit from physical therapy to maintain function and improve range of motion in the affected limb. Physical therapy often includes a gradually-increasing exercise program.
Intrathecal Drug Pumps to Treat RSD/CRPS
In this treatment for CRPS, medications for pain relief, such as opioids and local anesthetics, are delivered directly to pain receptors in the spinal cord via the spinal fluid. This method can increase the effectiveness of medicationsat lower doses than required when administered orallyand cause fewer side effects.
The National Institute of Neurological Disorders and Stroke (NINDS) supports and conducts research to find new methods of treating CRPS. Some studies are focused on preventing the disorder through aggressive intervention after a traumatic injury.