Pain in the Complex Regional Pain Syndrome Rehabilitation Patient


Treatment

Level of evidence

Physical treatments

Physical therapy [5456]

2

Occupational therapy [55, 56]

2

Graded motor imagery [27, 28]

2

Mirror therapy [57, 58]

2

Sensorimotor retuning [59, 60]

3

Injection therapies

Stellate ganglion block [61]

3

Lumbar sympathetic block [61]

3

Brachial plexus block [62]

4

Epidural analgesic infusion [63, 64]

3

Psychological treatments

Autogenic relaxation [46]

2

Biofeedback [47]

4

Psychotherapy [4850]

3

Intensive graded exposure therapy [51]

3

Pharmacological treatments

Bisphosphonates [2325]

1

Cation channel blockers [1315]

4

Oral corticosteroids [50]

1

Ketamine [12, 20, 21]

3

Opioids [1619]

4

Vitamin C [53]

1

Implanted device therapies

Spinal cord stimulation [3235]

2

Peripheral nerve stimulation [35]

3

Dorsal root ganglion stimulation [36]

2

Intrathecal drug infusion [7]

3






Conclusion


Complex regional pain syndrome is a rare but severe chronic pain condition. Though many questions remain both about the processes involved in the development of CRPS and the effective treatments, the available evidence supports a number of treatment modalities at different stages of treatment. Several forms of physical treatment , including physical and occupational therapy, have received research support, particularly in restoring function to the affected limb. A number of pharmacological treatments are utilized in treating CRPS and have varying levels of support. Opioids and cation channel blockers are widely used for CRPS, based on their efficacy in treating neuropathic pain more generally, though specific support in treating CRPS is primarily anecdotal. The use of vitamin C and oral corticosteroids, particularly early in the progress of CRPS, is supported by RCTs. Infusions of drugs such as ketamine and bisphosphonates appear to have the potential to provide lasting relief to some CRPS patients.

Anesthetic blocks , often of the sympathetic nerve pathways, are widely used in diagnosing and treating CRPS, with some supportive evidence. Additionally, given the suspected role of behaviors and psychological processes in at least some cases of CRPS, psychological interventions are often considered. These therapies may address stress, anxiety, and other dysphoric states that interact with physiological processes involved in the development of CRPS, and can therefore provide some CRPS patients with relief. For CRPS patients whose condition is refractory to other therapies, the use of implanted devices, particularly SCS, is supported. Many of these treatments can be delivered in a rehabilitation medical practice or coordinated with appropriate specialists.


References



1.

Azari P, Lindsay DR, Briones D, Clarke C, Buchheit T, Pyati S. Efficacy and safety of ketamine in patients with complex regional pain syndrome. CNS Drugs. 2012;26:216–28.CrossRef


2.

Lohnberg JA, Altmaier EM. A review of psychosocial factors in complex regional pain syndrome. J Clin Psychol Med Settings. 2013;20:247–54.CrossRef


3.

Marinus J, Moseley GL, Birklein F, Baron R, Maihöfner C, Kingery WS, van Hilten JJ. Clinical features and pathophysiology of complex regional pain syndrome. Lancet Neurol. 2011;10:637–48.CrossRef


4.

Watts D, Kremer MJ. Complex regional pain syndrome: a review of diagnostics, pathophysiologic mechanisms, and treatment implications for certified registered nurse anesthetists. AANA J. 2011;79:505–10.


5.

Azari P, Lu Y, Clarke CFM, Collins T, Briones D, Huh B. Pathophysiology of the spreading of complex regional pain syndrome revisited: a case report. Neuromodulation. 2011;14:428–31.CrossRef


6.

Cossins L, Okell RW, Cameron H, Simpson B, Poole HM, Goebel A. Treatment of complex regional pain syndrome in adults: a systematic review of randomized controlled trials published from June 2000 to February 2012. Eur J Pain. 2013;17:158–73.CrossRef


7.

Harden RN, Oaklander AL, Burton AW, Perez RSGM, Richardson K, Swan M, Barthel J, Costa B, Graciosa JR, Bruehl S. Complex regional pain syndrome: practical diagnostic and treatment guidelines, 4th edition. Pain Medicine. 2013;14:180–229.CrossRef


8.

Harden RN, Bruehl S, Stanton-Hicks M, Wilson PR. Proposed new diagnostic criteria for complex regional pain syndrome. Pain Med. 2007;8:326–31.CrossRef


9.

Schwartzman RJ. Systemic complications of complex regional pain syndrome. Neurosci Med. 2012;3:225–42.CrossRef


10.

Lee DH, Lee KJ, Cho KIK, Noh EC, Jang JH, Kim YC, Kang DH. Brain alterations and neurocognitive dysfunction in patients with complex regional pain syndrome. J Pain. 2015;16:580–6.CrossRef

Aug 26, 2017 | Posted by in Uncategorized | Comments Off on Pain in the Complex Regional Pain Syndrome Rehabilitation Patient

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