Specialist chronic pain solicitor Andrew Atkinson looks at the drugs most commonly used in treating CRPS.
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Let’s begin on a positive note. For those recently diagnosed with Complex Regional Pain Syndrome (CRPS), the evidence suggests you have a better than even chance of experiencing a full or partial remission of symptoms within two years.
But there’s no getting away from the fact that, for many people, the condition is life-changing. Although there are guidelines for treating and managing CRPS, there’s no known cure. Management is complex, primarily because what proves beneficial for one person may not be for another. By trial and error, your clinicians work with you to develop a combination of approaches – medication, physical and psychological therapies, nerve blocks, self-management, pain management programmes etc – that provide optimum relief.
Drugs for CRPS
Medication plays a crucial role in most individual pain management regimes. But just what drugs are available in the CRPS treatment arsenal?
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
NSAIDs such as Ibuprofen are available over-the-counter and are often among the first drugs used to treat CRPS before a formal diagnosis. However, NSAIDs are unlikely to benefit CRPS-related pain.
Pregabalin and Gabapentin
Pregabalin and Gabapentin are anticonvulsant drugs used in the treatment of epilepsy. But they can also prove helpful in treating severe neuropathic pain. Although often beneficial, side effects are common, including drowsiness, cognitive problems, weight gain, and dizziness.
Originally developed to treat depression, just like anticonvulsants, drugs such as Amitriptyline and Nortriptyline have proved effective in treating neuropathic pain. Generally, Nortriptyline has fewer side effects than Amitriptyline, but both have the ‘side benefit’ of aiding sleep. Other commonly reported side effects include constipation, dry mouth, heart palpitations, blurred vision, and difficulty urinating.
Buprenorphine is an opioid painkiller similar to Morphine, sometimes prescribed to people with CRPS and delivered through skin patches. Others receive Morphine itself (as Oramorph solution) or Codeine.
Commonly reported side effects of opiate painkillers include constipation, tiredness, dry-mouth, cognitive problems, nausea and vomiting. And their long-term use, particularly in higher doses, is linked to more severe health problems. The benefits of using opiates may sometimes outweigh the risks. However, like all drugs, they are often not very effective in reducing the pain of CRPS.
Combination of drugs
In most cases, people with CRPS take a combination of medications daily. Like all treatments and therapies, finding the combination that provides optimum benefit takes time. And unfortunately, the efficacy of each drug can then change over time.