For the doctor

Complex Regional Pain Syndrome (CRPS) early stage

It is a syndrome of unclear pathology, affecting most commonly hand and feet and comprising neuropathic and vasculopathic pain syndromes. Excruciating pain is the main characteristic and very often a trauma can be identified as a precipitating event.

Since there is no definitive diagnostic test , diagnose is based on clinical history and physical examination.
It affects relatively young people (36-42 years).

Treatment

The treatment of CRPS includes conservative treatments such as rehabilitation therapy, psychotherapy and pharmacotherapy including non opioids drugs such as Duloxetine (SSRI, NARI) Pregabaline ( GABA analog) and opioids such as Fentanyl tts 12µg, hydro Morphine ( Morphine X7) and Oxicodone ( Morphine X2).
For those patients with pain refractory to the conservative treatment, Spinal Cord Stimulation is indicated and is extremely valuable as an adjuvant therapy for these patients *.

Stellate ganglion nerve blocks and lumbar sympathetic nerve blocks can also be used, but have short term benefit.
*Stanton-Hicks, MD, Burton AW, Bruehl SP, Carr DB, Harden RN, et al. An updated interdisciplinary clinical pathway for CRPS: report of an expert panel. Pain Practice 2002; 2(1): 1-16

 

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