The treatment for Complex Regional Pain Syndrome (CRPS) is multifaceted and requires a multidisciplinary approach. It includes pharmacotherapy, physiotherapy, psychological support, and in some cases, interventional procedures.
Pharmacotherapy
- Ketamine: Intravenous ketamine, an NMDA antagonist, has shown effectiveness in treating CRPS in an outpatient setting
- Bisphosphonates and calcitonin: These have been suggested as potential treatments for CRPS
Physiotherapy
- Physical rehabilitation: A variety of physiotherapy interventions are recommended as part of the multimodal treatment of CRPS
- "Pain exposure" physical therapy (PEPT): This involves a progressive-loading exercise program and management of pain-avoidance behavior without the use of specific CRPS medication or analgesics
Interventional procedures
- Spinal cord stimulation (SCS): SCS has been found effective in the medium term for the treatment of CRPS I, although its long-term efficacy remains controversial
- Stellate ganglion blockade and radiofrequency neurolysis: These procedures have been used in the management of refractory type I CRPS of the upper limb
Psychological support
- Psychological support is an integral part of the treatment plan, addressing the psychological factors that may contribute to the syndrome
Mechanism-based treatment
- A mechanism-based treatment approach is suggested, where the clinical picture is related to the underlying pathophysiology to determine the pharmacotherapeutic approach for an individual patient
In conclusion, the treatment of CRPS is complex and requires a multidisciplinary, patient-tailored approach. The choice of treatment should be based on the individual patient's symptoms, the underlying pathophysiology, and the response to previous treatments.