One of the key elements in treating these disorders is to begin treatment as early as possible. Late onset treatment may not work as well. When the disease spreads up the arm or leg, it causes damage to the muscles so the patient develops dystonia in the muscles that can become very hard to treat later.
Researchers have also found that chronic pain can result in depression. (It turns out that white males have twice the suicide rate if they have chronic pain and white females have three times the suicide rate when they suffer from chronic pain.) What this means is that a person with CRPS may benefit from seeing a psychologist or psychiatrist being prescribed antidepressant therapy and other treatments. Tricyclic antidepressants are older antidepressants but seem to work better than even newer medications for the management of chronic pain. Family therapy, group therapy and patient education are particularly helpful when they are available.
In general, severe pain is treated with opioids but this type of medication doesn’t seem to work as well in cases of CRPS I and CRPS II. The pain receptors in these conditions don’t interact with opioids in a way that makes the pain go away.
A traditional treatment for RSD is a sympathetic nerve block. Initially a sympathetic block is used to diagnose the condition. The nerve is blocked, and if this results in a feeling of increased warmth associated with a reduction in pain, the block is considered successful both as a treatment and as a confirmation that CRPS is present. If the block works, it is typically followed by a series of 6 – 10 blocks. Following this series, the CRPS may disappear completely or it may go away for many months and come back again. In some cases, pain relief lasts just a few hours or a day.
Patients can also have what’s known as a surgical sympathectomy. In such cases, the sympathetic nerve is severed so that there can be no reoccurrence of symptoms.
If the case is extreme, epidural stimulation can be done. Medications like baclofen or opioids are used. In some cases, clonidine infusion is helpful for long term pain relief.
Treatment Flow Sheet
|Prednisone||80 mg taper||8 days||Go to next step|
|Physical therapy||Three times a week||2 weeks||Go to next step|
|Transcutaneous electrical stimulation||Worn continuously||1 week||Go to next step|
|Sympathetic blocks||3 times a week||2 weeks||If temporary, go to next step|
|Sympathectomy||Once||1 week recovery||If no relief, go to next step|
|Contralateral sympathectomy||Once||1 week recovery||If no relief, go to next step|
|Epidural spinal cord stimulator||once||1 week recovery||If no relief, go to next step|
|Epidural pump||Start with clonidine||1 week recovery||If no relief, go to next step|
|Psychotherapy||Use antidepressants||6-24 months||Maintenance|