Treatment Options for Complex Regional Pain Syndrome / Reflex Sympathetic Dystrophy

There are many treatment options once you are diagnosed with CRPS/RSD. The standard treatments are nerve blocks, physical therapy and medications. What follows are these options and more you can pursue.

The doctors who will usually perform sympathetic nerve blocks are pain management doctors who are also anesthesiologists. The two most common blocks done are the SGB or Stellate Ganglion Block which is done for the arms. A LSB or Lumbar Sympathetic Block is done for the legs and feet.

The blocks are performed with the aid of a fluoroscope, also known as a live x-ray. A combination of medications are injected into the nerve bundle to interrupt the pain signals. Some blocks, such as a Bier block is not recommended for those with CRPS/RSD. You should never have any procedure that calls for a needle to be injected directly into the affected limb. This particular treatment could cause a significant increase in pain. It also could cause the CRPS/RSD to spread.

Physical Therapy is important to keep the affected limb moving and to maintain range of motion. This treatment is helpful in strengthening muscles also, because lack of use can lead to atrophy and total loss of the use of the limb. If there are issues with touch sensitivity then part of the therapy can be a desensitization program.

At some places, they offer aqua therapy which can be very beneficial. It allows a person to exercise their body gently because the water takes the weight off the limb or limbs. Due to an inability to tolerate cold or cool temperatures with CRPS/RSD, aqua therapy in warm water is highly recommended. Land based physical therapy can be more painful. The saying, No pain, no gain, does not apply to those with CRPS/RSD.

Medications are often prescribed for pain control as well as other symptoms that are a part of CRPS/RSD. The different medications that may be given are opioids (long and/or short acting. e.g. Vicodin, percocet, tramadol,etc), nonsteroidal anti-inflammatory (e.g. aspirin, ibuprofen, naproxen, etc. for swelling), antidepressants (e.g. amitriptyline, doxepin, trazadone, etc), anti-convulsants (e.g. gabapentin, carbamazepine, etc), and muscle relaxers (e.g. baclofen, soma, clonazepam, etc).

Surgical options are an implantable spinal cord stimulator, also known as a SCS, morphine pump and a sympathectomy. These options should be thoroughly researched. The best way to gauge whether it may be right for you is to talk with others who have gotten it done and listen to their experiences.

Non-surgical options would be lidocaine infusions, continuous epidural infusions and the "awake" ketamine infusions. The ketamine coma is not approved for use in the United States. Infusions are given by IV drip in the hospital while you are closely monitored by a nurse or doctor for adverse side effects. The initial infusion takes about an hour. The purpose is to make sure it will relieve the pain and also to ensure the correct dosage. Depending on the doctor, follow up infusions can be done in the hospital or given via a pump which is clipped to the clothing.

Other options include a natural/holistic approach through the use of acupuncture, massage, herbal supplements, Tai Chi, Qi Gong, changing the diet and eliminating certain foods or drinks if you find they are causing an increase in the pain.

Seeing a psychiatrist or psychotherapist can help you deal with the emotional aspects that come with CRPS/RSD. Many people find it helpful to talk about their feelings about the sudden changes this has brought. It's also helpful because a psychiatrist can give you more coping tools to help ease depression or anxiety. The use of biofeedback has proven effective for many, as well as meditation and deep breathing techniques.

Treatment should be started as early as possible after symptoms start. There is a window of time, generally in the first three to six months, to use any and all options available. It comes down to finding what works for you. With knowledge of all options, a little research on your own, you're prepared to tackle CRPS/RSD.