Efficient Treatment for Complex Regional Pain Syndrome: A Critical Review.
Complex Regional Pain Syndrome (CRPS) is a neurological disorder, where one or more limbs are affected by pain disproportionate to the stimulus. Its exact pathology remains widely debated and there are currently several treatments available for the disease. No single treatment regimen has been proven to be superior, and there are no standardised guidelines or treatment algorithms.
This review aims to provide an update on the current evidence for the treatments available for CRPS management. It further seeks to explore the possible aetiology of the disease, and whether the proposed pathophysiology is associated with the efficacy of treatment(s).
The literature was searched across AMED, BNI, CINAHL, EMBASE, HBE, HMIC, Medline, PsycINFO, and PubMed databases. Only human-based studies published within the last 15 years, with more than 10 participants were included. Common intervention themes were pharmacotherapy, psychotherapy, physiotherapy, and neurosurgery.
There is a lack of strong evidence favouring any given method of CRPS treatment. Physiotherapy proved most efficient where it was patient-oriented and featured a long-term treatment with gradual pain exposure and concurrent psychiatric support. Pain-oriented pharmacotherapy was largely inefficient, with no evidence to support the use of ketamine, opioids, NSAIDs or local anaesthesia. The efficacy of bisphosphonate use and neurosurgical interventions, especially in the field of spinal stimulation proved particularly efficacious.
Despite a huge number of studies in the literature, there is currently no definitive evidence to support any given aetiology or treatment regime. However, a number of specific interventions have been shown to work, lending some support the case for a central reorganisation or peripheral change origin of the disease.