Treatments

Complex Regional Pain Syndrome Treatments

Treatments for complex regional pain syndrome (CRPS) include medication, non-drug treatment and surgery, psychotherapy, physical therapy and drug treatment.

Medication

Narcotics such as morphine, codeine, hydrocodone and oxycodone often are not effective for this type of pain. More often, medications that modulate the neurotransmitters in the brain are used to help control CRPS. Most of them were originally developed for other purposes such as:

• Antidepressants: Duloxetine, amitriptyline and nortriptyline
• Anticonvulsants: Gabapentin, carbamazepine, phenytoin, pregabalin, topiramate and levetiracetam

Non-medication options

• Psychotherapy: This helps patients develop coping skills and manage the stress that accompanies living with pain
• Physical therapy: In conjunction with nerve blocks, helps to break the pain cycle and has been shown to lessen the duration of pain and loss of function when started early in the course of the pain condition

Surgical treatments

• Sympathetic nerve blocks: These provide significant pain relief for some people. Types of nerve blocks include:
  
  • Anesthetic placed next to the spine to directly block the sympathetic nerves
  • Steroids to reduce inflammation
• Intrathecal drug pumps: Pumps and implanted catheters are used to continuously send pain-relieving medication into the spinal fluid.
• Spinal cord stimulation: In this minimally invasive technique, electrodes are placed in the spinal canal outside the sac containing the spinal cord, providing relief for many people with CRPS without medication-related side effects while allowing people significant control over their pain management.
• Motor cortex stimulation: Using computer-guided surgical techniques, stimulating electrodes are placed on the covering of the brain over the region controlling movement of the painful body area. An implanted pulse generator (battery) sends constant electric pulses to the area to relieve pain.
• Deep brain stimulation: One or two small wires are placed deep in the areas of the brain that relay pain signals. Microelectrode recording (brain mapping) techniques are used to precisely localize the area to place the electrode. An implanted pulse generator (battery) sends constant electric pulses to the area to relieve pain.