Complex Regional Pain Syndrome (CRPS)

Question 1

About CRPS

Answer 1

High rates of recurrence (10 - 30%)

Triggers may include
-spontaneously
-heat/cold exposure
-trauma/surgery to affected limb

Question 2

Pharmacotherapy in CRPS

Answer 2

Goal - participation in active rehabilitation

1) NSAIDS

2) Neuropathic pain agents
-gabapentanoids
-TCA’s
-SNRI
**if bone abnormal consider bisphosphonate course (early CRPS ONLY)

3) Topical
-lignocaine gel 2 - 5%
-capsaicin cream 0.025 - 0.075%

4) Alpha antagonist/agonists
-Prazosin
-Clonidine

Question 3

Intervention in CRPS

Answer 3

Sympathetic nerve blocks
-infiltration of local anaesthetic to sympathetic ganglia

Upper limb = Stellate ganglion (access via anterior neck)
Lower limb = Lumbar sympathetic ganglion (access via lumbar back)

Spinal Cord Stimulators
-if treatment resistant
-have money

Sympathectomy
-low quality evidence
-high rates of adverse effects (increased, new pain and sweating)
*should only be used with previous response to nerve blockade