neurologic disorders
Complex Regional Pain Syndrome (CRPS)
Treatment of CRPS
Multimodal therapy (eg, drugs, physical therapy, sympathetic blockade, psychologic treatments, neuromodulation, mirror therapy) The primary goal of all treatments for complex regional pain syndrome is to increase the mobility and use of the affected limb. Treatment of CRPS is complex and often does not result in complete relief of symptoms, particularly if begun late. It includes drugs, physical therapy, sympathetic blockade, psychologic treatments, and neuromodulation. Few controlled trials have been done. Many of the Drugs for Neuropathic Pain , including tricyclic antidepressants, antiseizure drugs, and corticosteroids, may be tried; none is known to be superior. Long-term treatment with Physical Therapy (PT) include desensitization, strengthening, increased range of motion, and vocational rehabilitation. In some patients with sympathetically maintained pain, regional sympathetic blockade relieves pain, making physical therapy possible. Oral analgesics (nonsteroidal anti-inflammatory drugs [NSAIDs], opioids, various adjuvant analgesics) may also relieve pain sufficiently to allow rehabilitation. Desensitization of an allodynic limb involves first applying stimuli that are relatively nonirritating (eg, silk) and, then over time, increasing to more irritating stimuli (eg, denim). Desensitization can also involve thermal contrast baths, in which the affected limb is placed in a cool water bath, then placed in a warm water bath. Mirror therapy has been reported to benefit patients with CRPS type 1 due to Complications or For neuromodulation, implanted spinal cord stimulators are commonly used; in severe cases with significant functional impairment, they should be considered early. Dorsal root ganglion stimulation may target localized symptoms. Electrical stimulation (TENS), applied at multiple locations with different stimulation parameters, may be effective but requires a long trial. Acupuncture may help relieve the pain. In patients with complex regional pain syndrome, psychotherapy may be used to treat depression and anxiety; it may also help patients successfully improve function and their control over their life despite the chronic pain disorder. 