Reflex Sympathetic Dystrophy (RSD/CRPS)

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Questions to Ask Your Doctor about RSD/CRPS
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Treatment

The goals of RSD/CRPS treatment are to control pain and maintain as much mobilization of the affected limb as possible. Treatment involves an individualized treatment plan, which often combines medications, physical therapy, nerve blocks, and psychosocial support.

Medication
Treatment for RSD/CRPS involves medications to control pain. The type of medication prescribed is determined by the type of pain experienced by the patient.

Constant pain caused by inflammation is treated using nonsteroidal anti-inflammatory drugs (NSAIDs; e.g., aspirin, ibuprofen, naproxen, indomethacin). Due to potenially severe gastrointestinal and cardiovascular side effects, NSAIDs should only be used as instructed.

Constant pain not caused by inflammation may be treated with central acting agents, such as tramadol (Ultram®).

Sharp pain and pain that disrupts sleep may be treated with antidepressants (e.g., amitriptyline, doxepin, nortriptyline, trazodone) or anticonvulsants (e.g., carbamazapine, pregabalin).

In some cases, generalized, severe pain that does not respond to other medications may be treated with opioids (e.g., propoxyphine, codeine, morphine).

Muscle cramps (spasms and dystonia) can be treated using clonazepam and baclofen.

Localized pain related to nerve injury may be treated with Capsaicin® cream, but the effectiveness of this medication to treat RSD/CRPS has not been proven.

Medications that affect the sympathetic nervous system such as clonidine (Catapres®) also may be useful in some cases.

Muscle stiffness may be treated with muscle relaxants such as

• Tizanidine (Zanaflex®)
• Baclofen
• Clonazepam (Klonopin®)

Physical Therapy
Physical therapy for RSD/CRPS involves daily range of motion exercises. Patients are advised to avoid activities that could accelerate osteoporosis or cause joint injury.

Nerve Block
Sympathetic nerve block interrupts the transmission of pain signals from a group of nerve cell bodies (called a ganglion). Nerve block should be performed by a physician who is familiar with the technique. This procedure involves inserting a needle into the appropriate location (e.g., alongside the windpipe [trachea], in the lower [lumbar] spine) and injecting an alpha adrenergic antagonist (type of anesthesia) into the ganglion.

When treating an upper extremity, this treatment is called a stellate ganglion block. The effects of the nerve block are monitored over time.

Sympathectomy
RSD/CRPS patients who have a good but temporary response to nerve block may be candidates for a surgical procedure called sympathectomy. This procedure involves cutting and sealing (cauterizing) a portion of the sympathetic nerve, which runs down the spine. The goal of treatment is to suppress sympathetic nervous system activity in the affected area. The role of sympathectomy to treat RSD/CRPS is controversial and in some cases, the procedure worsens symptoms.

TENS Unit
A transcutaneous electrical nerve stimulation (TENS) unit may be used to treat the affected area in patients who have RSD/CRPS. In some cases, a spinal cord stimulator is permanently implanted. This device supplies low-intensity impulses to a location in the spinal cord to interrupt the pain signals that are being transmitted to the brain.

Psychosocial Support
RSD/CRPS patients often become depressed and anxious because of chronic pain and reduced physical ability. Counseling, support groups, and chronic pain center programs can help patients learn coping strategies and can provide emotional and psychological support.

Reflex Sympathetic Dystrophy (RSD/CRPS), Treatment, Psychosocial Support reprinted with permission from neurologychannel.com
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