Complex Regional Pain Syndromes Medication

  • Author: Anthony H Wheeler, MD; Chief Editor: Stephen A Berman, MD, PhD, MBA   more...
 
Updated: Apr 3, 2012
 

Medication Summary

Clinical trials strongly suggest that steroids are effective when given in the acute phase of CRPS type I. This is probably related to their effects on neurogenic inflammation. Opioids can bring relief for acute as well as chronic pain. Intranasal calcitonin has been used successfully to treat CRPS-related pain.

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Corticosteroids

Class Summary

These agents have anti-inflammatory properties. They can cause profound and varied metabolic effects and modify the body's immune response to diverse stimuli.

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Methylprednisolone (Adlone, Medrol, Solu-Medrol)

 

Should be given in the acute phase of CRPS type I. May decrease inflammation by reversing increased capillary permeability and suppressing PMN activity. After 4 wk of treatment, symptoms and signs should be decreased by 65%.

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Prednisone (Sterapred)

 

Can be used in early phase of CRPS. Not useful in late stages. May decrease inflammation by reversing increased capillary permeability and suppressing PMN activity.

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Analgesics

Class Summary

Pain control is essential to quality patient care. Analgesics ensure patient comfort. They can have side effects such as sedation, constipation, or, rarely, respiratory depression.

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Morphine (Duramorph, Astramorph, MS Contin)

 

The opioid used most often; many physicians are probably more comfortable with this medication than other opioids. However, other available opioids can also be used in pain control. Starting dose may depend on whether patient is already taking narcotic analgesics. Large doses required in patients who have been taking opioid analgesics for a long time. Available orally in both immediate-release and timed-release preparations. Long-acting form usually dosed q12h, but many authorities believe it loses much of its effect after 8 h. Immediate-release form may be needed for periods of pain "breakthrough." Treatment should begin at the lowest available dose in newly diagnosed patients. Available preparations of oral morphine include MSIR, MS Contin, Oramorph, RMS (Purdue Frederick), and Roxanol (Roxane).

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Contributor Information and Disclosures
Author

Anthony H Wheeler, MD  Pain and Orthopedic Neurology, Charlotte, North Carolina

Anthony H Wheeler, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Pain Medicine, North American Spine Society, and North Carolina Medical Society

Disclosure: Allergan, Inc. Salary Speaking and teaching; Gralise None Consulting

Specialty Editor Board

Jorge E Mendizabal, MD  Consulting Staff, Corpus Christi Neurology

Jorge E Mendizabal, MD is a member of the following medical societies: American Academy of Neurology, American Headache Society, National Stroke Association, and Stroke Council of the American Heart Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Glenn Lopate, MD  Associate Professor, Department of Neurology, Division of Neuromuscular Diseases, Washington University School of Medicine; Director of Neurology Clinic, St Louis ConnectCare; Consulting Staff, Department of Neurology, Barnes-Jewish Hospital

Glenn Lopate, MD is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, and Phi Beta Kappa

Disclosure: Baxter Grant/research funds Other; Amgen Grant/research funds None

Chief Editor

Stephen A Berman, MD, PhD, MBA  Professor of Neurology, University of Central Florida College of Medicine

Stephen A Berman, MD, PhD, MBA is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, and Phi Beta Kappa

Disclosure: Nothing to disclose.

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CPRS: complex regional pain syndrome; SMP: sympathetically maintained pain.
 
 
 
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