Ways of treating CRPS?

Answer 1

Systemic medical treatment:

The acute stage responds well to cortisone treatment, e.g. methylprednisolone 80 mg/day for 4 to 5 days. The dosage is then slowly reduced over the next two weeks. Other causes of infection have to be excluded beforehand.
The administration of tricyclic antidepressants – a member of the antidepressant group of drugs - have shown useful in the treatment of Sudeck dystrophy. It is important to explain to the patient that the drug is not prescribed to treat depression, but for its well known pain reduction effect. Pain is eliminated by inhibition of serotonin reuptake – a neurotransmitter and hormone – as well as noradrenaline reuptake – a catecholamine and hormone stored in the adrenal medulla - which ban pain development and foster pain relief.
recommended dosage: amitriptyline (e.g. Laroxyl®) and clomipramine (e.g. Anafranil®) up to 150 mg/day.
Sudeck`s dystrophy and accordingly CR PS (Comp lex Reg ional Pain Syndrome) may be treated with antiepileptics - drugs that are used in the treatment of epilepsy – namely medication which has also proven useful in the treatment of Sudeck`s dystrophy (Tremount-Lukats et al. 2000). Gabapentin (Neurontin®) and pregabalin (Lyrica®) are today the most important drugs in this group. Depending on individual tolerance dosages may be increased rapidly.
It is difficult to give general recommendations for pain alleviating drugs based on large differences in individual patient response. Analgestics should be tested prior. However, in most cases centrally acting analgesics, e.g. drugs that act on the brain and the spinal cord, need to be administered.
Calcitonin, a hormone, may demonstrate favorable effects in Sudeck`s dystrophy, however, results in clinical trials are currently ambiguous and the authors have not been able to demonstrate significant positive results.
Intravenous administration of biphosphates (e.g.Ostac®) has also been recommended in the literature (Varenna M, et al 2000).
Phenoxybenzamine (Dibenzyran®) has been recommended for management (Thoden 1987). Our experience has not shown a positive effect, which justifies the considerable side effects encountered.
2) Localized medical treatment in Sudeck`s dystrophy:

DMSO (dimethylsulfoxide) (e.g. Rheumabene®) – fatty cream, applied 4 times /day (Zuurmond WW, 1996).
3) Specialized pain management/ therapeutic local anaesthesia

Continuous administration of therapeutic local anaesthesia using a local anesthetic has shown significant positive results in the management of Sudeck`s dystrophy.
For the upper limbs blockade of the stellate ganglion – a „vegetative switch“ on the side of the neck – using continuous ganglion blockade with an opium related drug employing a catheter has demonstrated positive therapeutic outcomes. Continuous blockade of the brachial plexus with the use of a catheter seems to show favorable results, because the network of nerves in the arm contains many vegetative fibers. Hence, next to the desired inhibition of nociceptors – a peripheral nerve organ or mechanism for the reception and transmission of painful stimuli – there is also an increase in blood circulation which in turn enhances prior disturbed microcirulation in the affected painful portion.

Within the lower limb region including the hips continuous block procedures are also applied.

· hip: continuous blockade of the lumbar plexus via femoral nerve catheter

· upper leg, knee, lower leg: continuous femoral nerve block (peripheral block)

· lower leg (back portion and side) as well as foot: continuous sciatic nerve block**

The femoral and the sciatic nerve also contain vegetative fibers, hence fostering the desired symphaticolysis - which has a vessel dilating and thus blood circulation enhancing effect.
Next step in management marks continuous epidural – close to the spinal cord - blockade with a catheter. Sudeck`s dystrophy may require longer block treatment often at least 2 to 3 weeks.

4) Additional therapeutic management in Sudeck`s dystrophy:

· Intravenous guanethidine blockade

· acupuncture

· physical therapy including ultrasound, which seems to be especially suitable for the disorder (Thomalske 1991).

· magnetic field therapy may also prove helpful

· Important management options are physiotherapy including lymphdrainage and functional ergotherapy treatments. Physiotherapy should not be strenuous or painful as this may lead to constriction of vessels with ensuing local dysfunction in metabolism. Physiotherapy is best done when pain transmission is mostly cut off by blockade treatment.

· hypnotic – mind altering – procedures including autogenic training, or progressive muscle relaxation according to Jakobson and pain-coping strategies mark sensible supportive measures.

Recently, our center has been able to demonstrate very good results employing SynOpsis therapy for the lower limbs. The lower legs are placed in a container filled with water. Sound waves of a predetermined frequency are transmitted pulse synchronously. This is also referred to as syncardial - namely in the same rhythm - tissue training. Enhancing blood circulation in this area causes improvement in localized metabolism disorders. Please go to: www.1-avk.de ,if you would like to find out more about this therapeutic option.

If chronic pain had been persisting in Sudeck dystrophy a chronic stage I or II - according to the Mainz classification - of the disease may be present. These cases will often not suffice with physical treatment, however, additional psychological counseling or psychotherapy may serve a very supportive function in management.

**Continuous blockade

A thin flexible tube is inserted close to the nerve network, or the nerve respectively, in a so-called continuous nerve blockade procedure employing a catheter. Implantation is done via a commercially available canula, hence „incisions“ are not necessary. The dosage of the local anesthetic is injected pain free several times daily depending on individual patient needs. A pump may also be connected for administration of local anesthetic, if necessary. The dosage of the anesthetic is adjusted to allow for sufficient muscle strength to do physiotherapy, hence in some cases physiotherapy can only be done with a supporting block, namely the inhibition of pain transmission. Pain alleviation usually lasts longer than the actual treatment, which may be due to involvement of vegetative nerve fibers in blockage leading to significant increase in blood circulation and thus resulting in improvement of local metabolism which is crucial in Sudeck`s dystrophy.
Newer clinical research has shown that intensive blockage therapy may erase so-called pain memory even in pain disorders based on Sudeck`s dystrophy.
Intensive nerve blockade treatment is only available in specialized clinics.

Our physicians are very experienced in treating Sudeck dystrophy. We have administered ongoing treatments for this disorder for several years.

* the new term coined by the International Association for the Study of Pain for Sudeck`s dystrophy is: CRPS Typ I = Comp lex Reg ional Pain Syndrome (Ref lex Sympathet ic Dyst rophy Syndrome)

Answer 2

In doing some studying into these types of pains there are so many of them that are just caused by tight tendons and/or muscles and they can be freed up to get rid of the pains. while they can be difficult to do it does get rid of the pains. The dr.'s go for what is in their books so they go and cut rather than working on what causes the problems and that's unfortunate.

Answer 3

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Answer 4

Check it out at: mayoclinic.com