Complex Regional Pain Syndromes Medication

Updated: Jun 20, 2018
  • Author: Gaurav Gupta, MD; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Medication

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.

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%.

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.

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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