Treatment
Level of evidence
Physical treatments
2
2
2
2
3
Injection therapies
Stellate ganglion block [61]
3
Lumbar sympathetic block [61]
3
Brachial plexus block [62]
4
3
Psychological treatments
Autogenic relaxation [46]
2
Biofeedback [47]
4
3
Intensive graded exposure therapy [51]
3
Pharmacological treatments
1
4
Oral corticosteroids [50]
1
3
4
Vitamin C [53]
1
Implanted device therapies
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.
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