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Hi friends, I am a patient of CRPS and was wondering if any of you guys have any experience in dealing with patients with CRPS (Complex Regional Pain Syndrome)? Have never really been happy with the outcome of these….especially following upper limb injuries….
I must say that there's hardly anything more resistant and difficult to treat than this condition. NSAID's, amitryptiline, alpha blockers, oral steroids, TENS, intensive physio….. all tried with no significant or persistant relief. Is there anything else that can be added prior to considering a chemical or surgical sympathetectomy? I will be glad to hear some comments on this.
2:28 am September 12, 2008
Tears
Member
posts 36
2
Very well said about the syndrome. It is called Complex Regional Pain Syndrome. It is classified in Type I and II. It is indeed sometimes very difficult to treat and requires multidrug treatment, psychotherapy. Sometimes it may be sympathetically mediated. Initial management usually can be started according to WHO pain management protocol. But very few patients respond with that protocol. Initially NSAIDs with or without codein can be tried. If not controlled neuropathic pain medication like amitryptilline and or gabapantine can be combined. If still there is no response chronic pain specialist better be consulted. Some times sympathetomy or IVRA with guanethedine may be tried
2:28 am September 12, 2008
Tears
Member
posts 36
3
Even after that patient compliance may not be adequate. Very little is known about it, still it is in the research process. You can also consult the online information or go through Text books related to pain management by Raj P or Bonica. What I have given here is very little outline about the complex thing. Hope this all will be of some use to you
Also, we deal with it quite often-both 1&2.mobilization/physiotherapy is the key .If early steallate ganglion block may be useful; we escalate to isolated limb block, iv lignocaine and pheytoin infusions. Pharmacologically we use gabapentin / pregabalin, TCAD/ssri,oral ketamine
2:30 am September 12, 2008
Tears
Member
posts 36
4
If you use a biopsychosocial model graded exercise programmes and psychological support, as you think it may help, as it does in everything, then in chronic pain it may not nothing works because, of early cortical re-wiring.
Again I am saying it is indeed very difficult to treat. Multidrug protocol is the key combined with psychotherapy. Psychological aspect is very important if patient fails to respond with initial management. Most of the chronic pain patients suffer from depression. So psychotherapy and antipsychotics will be of immense value. You have to initially try with multidrug treatment as mentioned by earlier and have to gradually increase the drug dose specially gabapantine, pregabaline and TCA to maximum to obtain acceptable pain relief.
2:32 am September 12, 2008
Tears
Member
posts 36
5
If they fail you have to consider chemical or surgical pain relief. You also can decide who will respond better to sympatholysis better by giving some series of stellate ganglion block with local anesthetics. If the patient responds you can consider for chemical or surgical sympatholysis of the limb. That will give better relief or will at least reduce drug requirement with improvement of quality of life and disability limitation. Hope this will be of some help. I will also ask others to comment more on this as people usually have very limited experience as well as knowledge in chronic pain management.
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