At the start I have to declare that I have no financial disclosure. I wrote these few lines to help some of the patients with CRPS.
Unfortunately many of people who read these lines, have been experiencing CRPS for a long time. It's already has changed the architecture of their spinal cord and brain. (the theory of the plasticity of central nervous system)
This is the reason I want to see every possible CRPS as soon as possible.
The only medication that has been shown to be effective in shortening of the duration of CRPS, if starts in the first 6 months, is vitamin C.
Gabapentin/ pregabaline (lyrica) is effective and safe for reducing the symptoms; however has never been shown the change the course of disease.
Cymbalta is a effective medication to control the pain and depression, however has never been shown the change the course of disease. Cymbalta is too new to know about the long term side effects and it's safety in long term.
Tramadol is safe and effective for control of the pain; however has never been shown the change the course of disease.
Narcotics are effective for control of the pain; however has never been shown the change the course of disease. Their safety in long term is under serious doubt.
IV lidocaine is safe and effective. It's an old medication and we know about it's safety.
sympathetic block with local anesthetic has a diagnostic value.
It's safe ONLY if performs by the guidance of ultrasound or x-ray.
When it combines with physiotherapy, as a way to reduce the pain and let the patient participate better in physiotherapy, could change the outcome to be more favorably.
Damaging or removing the Sympathetic ganglions is a more aggressive treatment. These treatment would be offer to a small subgroup of patients who failed other modalities. It's relatively safe when radiofrequency machine used under the guidance.
In some areas, like Montreal, injection of alcohol to kill the sympathetic ganglions has been used for a long time.
Spinal cord stimulator would be the last choice for a very small group of patient.
Deep brain stimulator has been used as case studies.
by far the most effective treatment of CRPS has been physiotherapy. (not chiropractor) Some times in last few years, a very scientific treatment model had been shown to be effective in stopping and reversing CRPS. It includes maneuvers that would increase the range of motion of the affected limb. As well it includes using hot and cold on the limb to re-program the sympathetic system.
Please ask your physiotherapist: if he/she is a registered physiotherapist and if he/she is aware of specific modality for the treatment of CRPS.
Mirror therapy: it's a very simple treatment that had been used to treat the phantom pain. In last few years, there has been enough evidence to convince me using it for my patients. It's very simple to apply. However it's difficult to explain why it works. I may try in the future. However now I just explain it:
You need a box that you can fit affected limb into
for example, I assume the affected limb is your right hand
insert the box on a table and place your right hand inside the box the way you can not see it. You may have to cover your wrist.
fix a mirror to the left side of the box
place your good hand, the left one, on the table, 30 cm away from the box
start doing the physiotherapy for increasing the rang-of-motion. Do it with both hands
because your eyes could see only the left hand on the left side and the mirror image of the good hand in the mirror, instead of the right hand, you will train your sensory part of your brain to accept that your right hand "is looking OK".
An Occupational therapist needs to assess your work place and home to make sure you are safe. Please listen to their advises, they could show you a smart way of living.
Repetitive, small trauma to the affected limb, like typing with the hand that had CRPS in the past, could flare up CRPS again. You need occupational therapist to look into your work situation, if the society wants to use your productivity for longer period of time. (use this sentence when you would like to ask for re-training)
meditation and the concept of "controlling your brain over your body" is very effective. Your could start reprogramming your brain with these techniques. Unfortunately not everyone could meditate very deeply. There are classes that can teach you different techniques.
Diet, healthy and balance diet is necessary. remember that vegetables have small trace of minerals that is necessary to balance the chemicals in your body.
Everyone in Canada needs supplement of vitamins D. 2000 IU to 4000 IU. there is no direct correlation between lack of vitamin D and CRPS. However in a pilot study in a chronic pain clinic, the researcher measured the blood level of Vitamin D in every patient. A large number of those people had lack of vitamin D.
Acupuncture and massage therapy has not been shown to be effective. Regarding acupuncture, there are more studies on the way.
Dr. Ramin Safakish, anesthesiologist and pain interventionist, is a full time pain interventionist in Allevio Pain Management.