Pharmacologic Management of Complex Regional Pain Syndrome

  title={Pharmacologic Management of Complex Regional Pain Syndrome},
  author={Michael C. Rowbotham},
  journal={The Clinical Journal of Pain},
  • M. Rowbotham
  • Published 1 June 2006
  • Medicine
  • The Clinical Journal of Pain
Few randomized controlled trials of oral pharmacotherapy have been performed in patients with complex regional pain syndrome (CRPS). The prevalence of CRPS is uncertain. Severe and advanced cases of CRPS are easily recognized but difficult to treat and constitute a minority compared with those who meet minimum criteria for the diagnosis. Unsettled disability or liability claims limit pharmaceutical industry interest in the disorder. Many studies are small or anecdotal, or are reported on only… 

Practical Management of Complex Regional Pain Syndrome

  • E. Hsu
  • Medicine
    American journal of therapeutics
  • 2009
An interdisciplinary setting with comprehensive approach (pharmacologic, interventional, and psychological in conjunction with rehabilitation pathway) has been proposed as protocol in the practical management of CRPS to facilitate further research to enhance clinical outcome including quality of life.

Intravenous Immunoglobulin Treatment of the Complex Regional Pain Syndrome

IVIG, 0.5 g/kg, can reduce pain in refractory CRPS, and studies are required to determine the best immunoglobulin dose, the duration of effect, and when repeated treatments are needed.

Prolonged ketamine infusion as a therapy for complex regional pain syndrome: synergism with antagonism?

The arguments for a role of prolonged ketamine infusion in the management of neuropathic pain and specifically for CRPS are articulated, and graded motor imagery, mirror visual feedback, spinal cord stimulation and transcranial magnetic stimulation are outlined.

Pharmacotherapy options for complex regional pain syndrome

Control trials have demonstrated that a short course of oral corticosteroids, intranasal or intramuscular calcitonin, intravenous bisphosphonates, free-radical scavengers, gabapentin, regional intravenous sympathetic blocks with bretylium and spinal cord stimulation or physical therapy and occupational therapy can be efficacious for complex regional pain syndrome.

Plasma Exchange Therapy in Patients with Complex Regional Pain Syndrome.

This study shows that PE is effective in a subset of patients with severe long-standing CRPS and that the reduction in pain following the initial series of PE treatments can be maintained on a weekly PE schedule, IVIG, or with other immune modulating drugs.

Four treatment strategies for complex regional pain syndrome type 1.

A protocol including a combination of IV 20% mannitol and steroid with oral gabapentin is an acceptable and effective treatment for CRPS type 1.

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

  • Minol
  • Medicine, Psychology
  • 2018
An early recognition, prompt initiation and a multidisciplinary approach including pharmacological, rehabilitation and psychological therapies seems to be effective in treating CRPS, to obtain an optimum outcome.

Can vitamin C prevent complex regional pain syndrome in patients with wrist fractures? A randomized, controlled, multicenter dose-response study.

Vitamin C reduces the prevalence of complex regional pain syndrome after wrist fractures and a daily dose of 500 mg for fifty days is recommended.

Long-term Outcomes Using Intrathecal Drug Delivery Systems in Complex Regional Pain Syndrome

The findings suggest that intrathecal opiates may not be effective in reducing oral opiate intake, ziconotide may hasten a decrease in intake, and bupivacaine may lead to an increase in intake.

Pieces of the puzzle: management of complex regional pain syndrome.

  • D. V. Nelson
  • Medicine, Psychology
    The Clinical journal of pain
  • 2006
The authors for this special series have generally been in the forefront of their respective disciplines in refining the focus on important issues about CRPS or neuropathic pain more broadly, including key issues in diagnosis and facilitating functional rehabilitation.



Treatment of complex regional pain syndrome type I

A review of existing randomized controlled trials of therapies forlex sympathetic dystrophy resulted in two eligible studies, one of high quality and dealt with different interventions and the other of limited evidence for their preventive effect.

Oral opioid therapy for chronic peripheral and central neuropathic pain.

The reduction in the intensity of neuropathic pain was significantly greater during treatment with higher doses of opioids than with lower doses, and higher doses produced more side effects without significant additional benefit in terms of other outcome measures.

Bisphosphonate therapy of reflex sympathetic dystrophy syndrome

Results indicate that bisphosphonates should be considered for the treatment of RSDS, producing consistent and rapid remission of the disease.

Controlled-release oxycodone for pain in diabetic neuropathy

In this 6-week trial, CR oxycodone was effective for the treatment of moderate to severe pain due to diabetic neuropathy and the most common adverse events were opioid related.

Efficacy of oxycodone in neuropathic pain: a randomized trial in postherpetic neuralgia.

Controlled-release oxycodone is an effective analgesic for the management of steady pain, paroxysmal spontaneous pain, and allodynia, which frequently characterize postherpetic neuralgia.

Intravenous clodronate in the treatment of reflex sympathetic dystrophy syndrome. A randomized, double blind, placebo controlled study.

A 10 day i.v. clodronate course is better than placebo and effective in the treatment of RSDS and NTx seems to be a predictive factor for clodonate efficacy.

Concentration–Effect Relationship of Intravenous Lidocaine on the Allodynia of Complex Regional Pain Syndrome Types I and II

It is demonstrated that intravenous lidocaine affects pain in response to cool stimuli more than mechanical pain in subjects with neuropathic pain.

Pharmacologic treatment of complex regional pain syndrome I: a conceptual framework.

A conceptual framework in which the rapid progress made in basic pain research may contribute to the clinical management of pain in CRPS I is discussed, in an effort to shift from a mainly empirical treatment paradigm toward theory-driven treatment procedures.