Sadly, there is no cure for Complex Regional Pain Syndrome (CRPS). As such, there are no CRPS treatment guidelines. Whilst a proportion of sufferers will notice a very gradual improvement in their condition over the first couple of years after developing the condition, many notice no improvement or suffer a deterioration.
The common delay in diagnosising CRPS means that treatments that may have proved beneficial early on, may be of less benefit once the condition has become established.
Please check out our Blog where we frequently post articles looking at the latest developments in treatment for CRPS. We are often among the first to report on important developments.
Medication is effective in less than two thirds of sufferers.
Achieving the right balance of medication can often prove difficult. Very broadly speaking, the stronger the analgesic (painkilling) effect of the medication, the greater side effects it will have, particularly cognitively, upon the individual and therefore the more difficult it will become to function on a daily basis. The pain may be less, but tiredness, lack of concentration, poor memory and reaction time, may be the price to pay.
- Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) – often the starting point prior to diagnosis, NSAIDs are unlikely to have any effect upon pain caused by CRPS.
- Anticonvulsants – whilst anticonvulsant drugs such as Pregabalin and Gabapentin are commonly used to treat epilepsy, they are also prescribed for serious neuropathic pain. However, clients often report to us major cognitive side effects. One described feeling “like a zombie. I was no use to anyone.”
- Tricyclic Antidepressants – Amitriptyline or Nortriptyline are often prescribed to chronic pain sufferers as they have been found to be helpful for nerve pain. One side effect, or as some clients have described it “a side benefit”, is that it also aids sleep.
- Opiates – Some chronic pain sufferers are prescribed Buprenorphine (which is similar to Morphine) as skin patches, or even Morphine itself, usually as Oramorph solution.
Sympathetic Nerve Block
Some CRPS sufferers gain temporary pain relief from sympathetic nerve blocks. This is, however, no evidence that nerve blocks can provide long term benefit.
The procedure involves an injection of anaesthetic next to the spine to both interrupt the activity of the sympathetic nerves and to improve blood flow.
More generally utilised as part of a multi-disciplinary pain management programme, the techniques used may include gentle exercise and weight bearing, as well as hydrotherapy.
A commonly used technique is Desensitisation, which is designed to reduce sensitivity by focusing on how different materials feel against unaffected parts of the body.
Relaxation techniques and guidance on pacing yourself are skills which are very useful on a daily basis. Occupational therapists are often brought in to help CRPS sufferers develop these skills.
Mirror Box Therapy (or Mirror Visual Feedback)
This is one of the oldest treatments used for CRPS. The equipment is simple, comprising a box and a specially placed mirror. Using the unaffected limb, the idea is to trick the person’s brain into thinking that the symptoms of CRPS have disappeared.
Pain Management Programmes
Most hospitals run pain management programmes. Whilst a programme will usually be coordinated by a consultant in pain medicine, the treatment is multi-disciplinary and as such, the sufferer may also receive input from physiotherapists, occupational therapists and psychologists.
Unfortunately, pain management programmes are not curative, but can help to improve function and mood and therefore quality of life.
There are a few residential programmes, available both privately and within the NHS. The specialist CRPS programme available at the Bath Centre for Pain Services is recognised as one of the best available. The intensity of the therapy on these residential programmes often significantly improves the prospects of a positive outcome. We have been hugely successful in arranging funding for clients to attend these residential programmes.
Spinal Cord Stimulation
For some chronic pain conditions, the implantation of a spinal cord stimulator can help to provide long term pain relief.
The procedure is invasive, as it involves the insertion of electrodes into the epidural space in the spine. These are connected to a battery powered device which is implanted under the skin and controlled externally by remote control. The device delivers electronic signals which, it is hoped, will interrupt the pain signals to the brain.
A number of our clients have undergone the procedure. Whilst all have reported a reduction in levels of pain, the degree of pain relief experienced has varied considerably.
Some sufferers find alternative therapies effective for short term relief of their symptoms, particularly therapies aimed at relaxation. Yoga, meditation, acupuncture and gentle, low-impact exercise are particular popular.
Whilst medical trials are outside of the scope of their claims, several of our clients have been selected to take part in medical trials, sometimes with encouraging results.