Complex Regional Pain Syndromes: Guidelines for Therapy

Abstract

This report aims to present an orderly approach to the treatment of Chronic Regional Pain Syndrome (CRPS) types I and II through an algorithm. The central theme is functional restoration: a coordinated but progressive approach that introduces each of the treatment modalities needed to achieve both remission and rehabilitation. Reaching objective and measurable rehabilitation goals is an essential element. Specific exercise therapy to reestablish function after musculoskeletal injury is central to this functional restoration. Its application to CRPS is more contingent on varying rates of progress that characterize the restoration of function in patients with CRPS. Also, the various modalities that may be used, including analgesia by pharmacologic means or regional anesthesia or the use of neuromodulation, behavioral management, and the qualitatively different approaches that are unique to the management of children with CRPS, are provided only to facilitate functional improvement in a stepwise but methodical manner. Patients with CRPS need an individual approach that requires extreme flexibility. This distinguishes the management of these conditions from other well-described medical conditions having a known pathophysiology. In particular, the special biopsychosocial factors that are critical to achieving a successful outcome are emphasized. This algorithm is a departure from the contemporary heterogeneous approach to treatment of patients with CRPS. The underlying principles are motivation, mobilization, and desensitization facilitated by the relief of pain and the use of pharmacologic and interventional procedures to treat specific signs and symptoms. Self-management techniques are emphasized, and functional rehabilitation is the key to the success of this algorithm.

Effects of Low-Level Laser Therapy and Interferential Current Therapy in the Treatment of Complex Regional Pain Syndrome

“…The multifactorial etiology of CRPS I and the complexity of the pathophysiological mechanisms influence the multidisciplinary therapeutic approach (25)(26)(27)(28)(29)(30). However, the application of a multidisciplinary approach does not provide the expected results, because a high percentage of patients still have dysfunction of the affected extremity after therapy (23,24).…”

Pharmacological and Non-pharmacological Treatment for Complex Regional Pain Syndrome (CRPS): A Review

“…In addition, they cause blockade of sodium channels of injured axons. 31 Amitriptyline remains the most commonly used drug in this class. Dosage starts at 10 mg nocte, gradually titrated up to 75 mg nocte as necessary.…”

Central Sensitization: Clinical Implications for Chronic Head and Neck Pain

“…As such, manual therapy, from a clinical perspective, is an intervention to address functional rehabilitation. [4,13,[60][61][62][63][64] Virtual Reality Though there is limited evidence, virtual reality has gained some support. Its effect is thought to derive from distraction in the hyper-vigilant patient, and would thus have potential benefit in patients with movement associated nociceptive etiology.…”

“…This is best accomplished with adequate anesthesia, analgesia and inflammation control in the acute phase; early psychosocial intervention; and thorough patient education. [2,61,62,74] Unfortunately, once initiated central sensitization will engender additional presentations (Figure 1. ), which increase the frequency and intensity of pain, and thereby increase the endogenous stress levels.…”