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Treatments and drugs
By Mayo Clinic staffImprovement and even remission of complex regional pain syndrome is possible if treatment begins within a few months of your first symptoms. Often, a combination of various therapies is necessary. Your doctor will tailor your treatment based on your specific case. Treatment options include:
Medications
Doctors use various medications to treat the symptoms of complex regional pain syndrome.
- Pain relievers. Over-the-counter (OTC) pain relievers, such as aspirin, ibuprofen (Advil, Motrin, others) and naproxen (Aleve), may ease pain and inflammation. Your doctor may prescribe stronger pain relievers if OTC ones aren't helpful. Opioid medications may be an option. Taken in appropriate doses, they may provide acceptable control of pain. Some pain medications, such as celecoxib (Celebrex), may increase your risk of heart attack and stroke. Be sure to discuss your individual risks with your doctor.
- Antidepressants and anticonvulsants. Sometimes antidepressants, such as amitriptyline, and anticonvulsants, such as gabapentin (Neurontin), are used to treat pain that originates from a damaged nerve (neuropathic pain).
- Corticosteroids. Steroid medications, such as prednisone, may reduce inflammation and improve mobility in the affected limb.
- Bone-loss medications. Your doctor may suggest medications to prevent or stall bone loss, such as alendronate (Fosamax) and calcitonin (Miacalcin).
- Sympathetic nerve-blocking medication. Injection of an anesthetic to block pain fibers in your affected nerves may relieve pain in some people.
Therapies
- Applying heat and cold. Applying cold may relieve swelling and sweating. If the affected area is cool, applying heat may offer relief.
- Topical analgesics. Various creams are available that may reduce hypersensitivity, such as lidocaine or a combination of ketamine, clonidine and amitriptyline.
- Physical therapy. Gentle, guided exercising of the affected limbs may help decrease pain and improve range of motion and strength. The earlier the disease is diagnosed, the more effective exercises may be.
- Transcutaneous electrical nerve stimulation (TENS). Chronic pain is sometimes eased by applying electrical impulses to nerve endings.
- Biofeedback. In some cases, learning biofeedback techniques may help. In biofeedback, you learn to become more aware of your body so that you can relax your body and relieve pain.
- Spinal cord stimulation. Your doctor inserts tiny electrodes along your spinal cord. A small electrical current delivered to the spinal cord results in pain relief.
Recurrences of complex regional pain syndrome do occur, sometimes due to a trigger such as exposure to cold or an intense emotional stressor. Recurrences may be treated with small doses of antidepressant or other medication.
References
- Sheon RP. Etiology, clinical manifestations, and diagnosis of complex regional pain syndrome in adults. http://www.uptodate.com/home/index.html. Accessed Jan. 13, 2011.
- Sheon RP. Prevention and management of complex regional pain syndrome in adults. http://www.uptodate.com/home/index.html. Accessed Jan. 13, 2011.
- Complex regional pain syndrome fact sheet. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/reflex_sympathetic_dystrophy/detail_reflex_sympathetic_dystrophy.htm. Accessed Jan. 13, 2011.
- Neuropathic pain. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/sec16/ch209/ch209c.html#sec16-ch209-ch209c-285. Accessed Jan. 13, 2011.
- Shipton EA. Complex regional pain syndrome — Mechanisms, diagnosis, and management. Current Anaesthesia & Critical Care. 2009;20:209.
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