How is complex regional pain syndrome (CRPS) treated?
There is no cure for complex regional pain syndrome (CRPS). The goal of treatment is to decrease your pain and other symptoms, restore function to the affected limb, and maintain the quality of your life.
It’s important to start treatment early in the course of CRPS. This is because CRPS can cause the affected limb to stiffen over time, the pain usually worsens without treatment, and movement becomes more and more difficult.
Treatment of CRPS requires a combination of approaches carefully managed by physicians and therapists who are experienced in this complex condition.
Treatment methods include:
Physical therapy and occupational therapy: A physical therapist can help improve blood flow to your affected limb as well as increase your flexibility, strength, muscle tone and function. An occupational therapist can teach you new ways to accomplish everyday tasks.
Mirror therapy: This treatment technique uses a mirror to trick your brain into perceiving movement in the affected limb without pain. Looking at the reflection of movement of your unaffected limb in a mirror fools your brain into thinking you are moving two normal limbs.
Desensitization: This technique involves touching the affected area with materials of different textures and weights and even placing the affected limb into water of warmer and cooler temperatures. By exposing the affected area/limb to different sensations slowly over time, your brain adjusts to the sensations and pain begins to lessen.
Psychotherapy: Having CRPS increases anxiety, depression and stress, which can increase pain. Psychotherapy (“talk therapy”) involves learning ways to better cope with these and other factors that contribute to your pain and disability.
Medications: No medications are specifically approved for CRPS in the U.S. However, many drugs from different drug classes can be tried. Topical analgesic creams and patches (such as lidocaine) might help relieve pain. Other anesthetic medications and/or medications that have pain-reducing effects include ketamine, dextromethorphan, opioids, some antidepressants (such as amitriptyline and duloxetine [Cymbalta®]), anti-seizure drugs (such as gabapentin [Neurontin], pregabalin [Lyrica®], topiramate [Topamax®]), nonsteroidal anti-inflammatory drugs (such as aspirin, ibuprofen [Advil®, Motrin®], naproxen), bisphosphonates (such as alendronate [Fosamax®]) and botulinum toxin injections.
Choice of medication(s) to begin with varies from patient to patient. Your healthcare provider will consider such factors as your age, other existing health conditions, any current medications you are taking, and the potential for medication side effects or interactions with the current medications you are taking.
If your CRPS has not responded well to the medications mentioned above or you have severe pain or ongoing CRPS, the following more invasive treatments can be tried:
- Sympathetic nerve blocks: These blocks can provide significant pain relief for some people. One kind of block involves injecting an anesthetic next to the spine to directly block/interrupt the pain signal.
- Intrathecal drug pumps: This treatment involves using an implanted catheter to send pain-relieving drugs, such as ziconotide (Prialt®), right into the spinal fluid.
- Spinal cord stimulation: This treatment involves surgically implanting a pulse generator device under your skin in your abdomen or buttock and electrodes near your spinal cord. The device, which is similar to a pacemaker, sends low level electrical current to the spinal cord. Electrical pulses stimulate the nerves where your pain is felt. These pulses interfere with the pain signal being sent to the brain. This treatment is usually considered only if you are in severe pain and all other treatment methods have failed to reduce your pain.
- Dorsal root ganglia stimulation: This treatment is similar to spinal cord stimulation except that the electrodes are implanted on the dorsal root ganglion, which is a cluster of neurons in the root of the spinal cord. The stimulation is a more targeted therapy that concentrates stimulation where doctors think the pain originates. Again, like spinal cord stimulation, it is usually considered only if you are in severe pain and all other treatment methods have failed to reduce your pain.
Again, choice of treatment, length of treatment, how soon to try these more invasive treatments will vary from patient to patient. Discuss these options with your healthcare provider and ask if any are appropriate for you (if needed).