Saturday, February 7, 2009

treatment of CRPS


How is Complex Regional Pain Syndrome Treated?



Because there is no cure for complex regional pain syndrome, treatment is aimed at relieving painful symptoms so that people can resume their normal lives. The following therapies are often used: • Physical therapy: A gradually increasing physical therapy or exercise program to keep the painful limb or body part moving may help restore some range of motion and function.
• Psychotherapy: Complex regional pain syndrome often has profound psychological effects on people and their families. Those with complex regional pain syndrome may suffer from depression, anxiety, or post-traumatic stress disorder, all of which heighten the perception of pain and make rehabilitation efforts more difficult.
• Sympathetic nerve block: Some patients will get significant pain relief from sympathetic nerve blocks. Sympathetic blocks can be done in a variety of ways. One technique involves intravenous administration of phentolamine, a drug that blocks sympathetic receptors. Another technique involves placement of an anesthetic next to the spine to directly block the sympathetic nerves.
• Medications: Many different classes of medication are used to treat complex regional pain syndrome, including:
• topical analgesic drugs that act locally on painful nerves, skin, and muscles
• antiseizure drugs
• antidepressants
• corticosteroids
• opioids
However, no single drug or combination of drugs has produced consistent long-lasting improvement in symptoms.
• Surgical sympathectomy: The use of surgical sympathectomy, a technique that destroys the nerves involved in complex regional pain syndrome, is controversial. Some experts think it is unwarranted and makes complex regional pain syndrome worse; others report a favorable outcome. Sympathectomy should be used only in patients whose pain is dramatically relieved (although temporarily) by selective sympathetic blocks.
• Spinal cord stimulation: The placement of stimulating electrodes next to the spinal cord provides a pleasant tingling sensation in the painful area. This technique appears to help many patients with their pain.
• Intrathecal drug pumps: These devices administer drugs directly to the spinal fluid, so that opioids and local anesthetic agents can be delivered to pain-signaling targets in the spinal cord at doses far lower than those required for oral administration. This technique decreases side effects and increases drug effectiveness.
What is the Prognosis of Complex Regional Pain Syndrome?
The prognosis for complex regional pain syndrome varies from person to person. Spontaneous remission from symptoms occurs in certain people. Others can have unremitting pain and crippling, irreversible changes in spite of treatment. Some doctors believe that early treatment is helpful in limiting the disorder, but this belief has not yet been supported by evidence from clinical studies. More research is needed to understand the causes of complex regional pain syndrome, how it progresses, and the role of early treatment.

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