How Is CRPS Treated?

While no cure has yet been discovered for complex regional pain syndrome (CRPS), there are several treatments used to alleviate the pain felt by those afflicted with the disorder. These include physical and occupational therapy, electronic stimulation in the affected areas, and drug treatment. Some of the more effective treatments include:

• Physical therapy: Physical therapy is especially important in making sure the affected limb retains a normal range of motion and muscle groups continue to get exercise. Sometimes this can be done in concert with a light local or general anesthetic to help remobilize the affected limb without causing undue pain to the patient. For many patients, specific therapies work better than others.

Transcutaneous electrical nerve stimulation is used to stimulate nerve endings, relieving some of the pain that patients may feel in the affected areas. Physical therapy methods based on progressive weight bearing allow the afflicted person to build up a tolerance to the pain, or to desensitize the affected limb over time, while still maintaining muscle groups and range of motion. Massage has also been useful for some patients in desensitizing the affected limb and loosening up contracted muscle groups.

“Pain exposure” physical therapy is a type of therapy that addresses psychosocial and behavioral aspects of pain. Contrary to some treatments, this type of therapy seeks to reduce pain avoidance behaviors, encouraging patients to develop a confidence in their own abilities and limits while facing the pain instead of constantly avoiding it. This treatment is still largely untested, but one study did reveal positive results.

• Drugs: Physicians recommend a variety of drugs to treat CRPS, some of which have proven more effective than others. Antidepressants and anti-inflammatory drugs are common treatments, with corticosteroids and COX (cyclooxygenase) inhibitors being the most common treatment of inflamed tissue. A wide variety of opioids are used to lessen the pain. Many of the drugs are used in concert with physical therapy or other treatments.

• Local anesthetic injections: A local anesthetic such as lidocaine may be used in diminishing the pain for the afflicted individual, and in fact is often used as the first step in treatment. The injections do not last very long, and may need to be repeated often in order to be effective. A pump can also be installed, in which the afflicted person could self-medicate with the anesthetic as needed.

• Spinal cord simulators: Surgically implanted by highly trained surgeons, these devices consist of electrodes attached to the area of the spinal cord associated with the affected region. The electrodes are programmed to stimulate the spinal cord according to the levels of pain the patient has been experiencing. Research has shown a statistically significant difference between the pain levels of patients treated with spinal cord stimulators as compared to patients without this particular treatment.

• Bisphosphonates, a specific class of drugs used to prevent bone loss, have also been used in the treatment of CRPS. Despite their normal use as a treatment for osteoporosis and other degenerative bone disorders, treatment of CRPS with bisphosphonates has been surprisingly effective.