Treatment

The treatment of complex regional pain syndrome is best commenced as soon as the diagnosis is made. Late treatment is associated with a poorer recovery. Management is multi-modal including:

• treat the cause: if a clear inciting stimulus is identifed, this is best treated eg ongoing nerve entrapment treated by surgical release

There are a variety of treatments which have been used in this condition including:

• physiotherapy:
  • heat packs
  • joint stretches
  • muscle-strengthening exercises
  • limb elevation
  • compression wraps or gloves
  • desensitisation regimens
  • functional tasks
  • biofeedback
  • TENS
    
    
• pharmacological:
  • analgesics including anti-inflammatories such as steroids and NSAIDs
  • antidepressants eg amitryptylline
  • gabapentin
  • calcium channel blockers
  • sympatholytics eg prazosin
    
    
• psychological:
  • reassurance
  • teaching of coping stratergies
    
    
• surgery:
  • relieve any ongoing inflammatory stimulus eg compression of a nerve, fixation of fracture
  • surgical sympathectomy
  • spinal cord stimulators
  • removal of a subclavian vein stenosis if present
  • as a last resort, amputation for patients with severe, intractable pain

There are few high quality randomized controlled trials are available to support the efficacy of the most commonly used interventions (4)

• reviews of available randomized trials suggest that physical and occupational therapy (including graded motor imagery and mirror therapy), bisphosphonates, calcitonin, subanesthetic intravenous ketamine, free radical scavengers, oral corticosteroids, and spinal cord stimulation may be effective treatments (4)

Reference:

• Albazaz R et al. Complex regional pain syndrome: A review. Ann Vasc Surg 2008; 22:297-306
• Field, J. & Atkins, RM. . Effect of guanethidine on the natural history of post-traumatic algodystrophy. Ann. Rheum. Dis. 1993;52(6), 467-9.
• Editorial NEJM 2000, 343, 654-655
• Bruehl S. Complex regional pain syndrome. BMJ. 2015 Jul 29;351:h2730.