Complications
If complex regional pain syndrome isn't
diagnosed and treated early, the disease may progress to more disabling signs
and symptoms. These may include:
Atrophy : If you avoid moving an arm or a
leg because of pain or if you have trouble moving a limb because of stiffness,
your skin, bones and muscles may begin to deteriorate and weaken.
Contracture: You also may experience
tightening of your muscles. This may lead to a condition in which your hand and
fingers or your foot and toes contract into a fixed position.
Treatment
There's no known cure for complex regional
pain syndrome (CRPS), but a combination of physical treatments, medication and
psychological support can help manage the symptoms.
Response to treatment of RSD is greater in
the earlier stages of the condition than in the later stages.
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. 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.
Antidepressants and anticonvulsants. Sometimes antidepressants, such as amitriptyline, and
anticonvulsants, such as gabapentin (Gralise, 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.
Intravenous ketamine.
Studies show that low doses of intravenous ketamine, a strong anesthetic, may
substantially alleviate pain. However, despite pain relief, there was no
improvement in function.
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 topical treatments are available
that may reduce hypersensitivity, such as capsaicin cream (Capsin, Capsagel,
Zostrix) or lidocaine patches (Lidoderm, others).
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.
Prognosis
Response to treatment in patients with RSD
is unpredictable. As previously mentioned, instituting treatment early in the
course of the condition leads to better outcomes.
Prevented
There is some evidence that early
immobilization of patients with stroke or heart attack can help decrease the
chances of developing RSD. Also, there have been studies demonstrating a decrease
in the risk of developing RSD in patients with bony fractures using daily
Vitamin C supplementation.
