Algorithm for multimodal medication therapy in patients with complex regional pain syndrome
Complex regional pain syndrome (CRPS), previously known as reflex sympathetic dystrophy and causalgia, is a clinical entity characterized by classic neuropathic pain, autonomic involvement, motor symptoms, and trophic changes in the skin, nails, and hair. Although various therapeutic modalities are...
| Main Authors: | , |
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| Format: | Article |
| Language: | English |
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Yeungnam University College of Medicine, Yeungnam University Institute Medical Science
2023-11-01
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| Series: | Journal of Yeungnam Medical Science |
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| Online Access: | http://www.e-jyms.org/upload/pdf/jyms-2023-00360.pdf |
| _version_ | 1827630188221956096 |
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| author | Min Cheol Chang Donghwi Park |
| author_facet | Min Cheol Chang Donghwi Park |
| author_sort | Min Cheol Chang |
| collection | DOAJ |
| description | Complex regional pain syndrome (CRPS), previously known as reflex sympathetic dystrophy and causalgia, is a clinical entity characterized by classic neuropathic pain, autonomic involvement, motor symptoms, and trophic changes in the skin, nails, and hair. Although various therapeutic modalities are used to control CRPS-related pain, severe pain due to CRPS often persists and progresses to the chronic phase. In this study, we constructed an algorithm for multimodal medication therapy for CRPS based on the established pathology of CRPS. Oral steroid pulse therapy is recommended for initial pain management in patients with CRPS. Oral steroid therapy can reduce peripheral and central neuroinflammation, contributing to the development of neuropathic pain during the acute and chronic phases. If steroid pulse therapy offers poor relief or is ineffective, treatment to control central sensitization in the chronic phase should be initiated. If pain persists despite all drug adjustments, ketamine with midazolam 2 mg before and after ketamine injection can be administered intravenously to inhibit the N-methyl D-aspartate receptor. If this treatment fails to achieve sufficient efficacy, intravenous lidocaine can be administered for 2 weeks. We hope that our proposed drug treatment algorithm to control CRPS pain will help clinicians appropriately treat patients with CRPS. Further clinical studies assessing patients with CRPS are warranted to establish this treatment algorithm in clinical practice. |
| first_indexed | 2024-03-09T14:03:31Z |
| format | Article |
| id | doaj.art-0f132a8e9b064c11b9c029bb21f11b97 |
| institution | Directory Open Access Journal |
| issn | 2799-8010 |
| language | English |
| last_indexed | 2024-03-09T14:03:31Z |
| publishDate | 2023-11-01 |
| publisher | Yeungnam University College of Medicine, Yeungnam University Institute Medical Science |
| record_format | Article |
| series | Journal of Yeungnam Medical Science |
| spelling | doaj.art-0f132a8e9b064c11b9c029bb21f11b972023-11-30T05:27:12ZengYeungnam University College of Medicine, Yeungnam University Institute Medical ScienceJournal of Yeungnam Medical Science2799-80102023-11-0140SupplS125S12810.12701/jyms.2023.003602796Algorithm for multimodal medication therapy in patients with complex regional pain syndromeMin Cheol Chang0Donghwi Park1 Department of Physical Medicine and Rehabilitation, Yeungnam University College of Medicine, Daegu, Korea Department of Rehabilitation Medicine, Daegu Fatima Hospital, Daegu, KoreaComplex regional pain syndrome (CRPS), previously known as reflex sympathetic dystrophy and causalgia, is a clinical entity characterized by classic neuropathic pain, autonomic involvement, motor symptoms, and trophic changes in the skin, nails, and hair. Although various therapeutic modalities are used to control CRPS-related pain, severe pain due to CRPS often persists and progresses to the chronic phase. In this study, we constructed an algorithm for multimodal medication therapy for CRPS based on the established pathology of CRPS. Oral steroid pulse therapy is recommended for initial pain management in patients with CRPS. Oral steroid therapy can reduce peripheral and central neuroinflammation, contributing to the development of neuropathic pain during the acute and chronic phases. If steroid pulse therapy offers poor relief or is ineffective, treatment to control central sensitization in the chronic phase should be initiated. If pain persists despite all drug adjustments, ketamine with midazolam 2 mg before and after ketamine injection can be administered intravenously to inhibit the N-methyl D-aspartate receptor. If this treatment fails to achieve sufficient efficacy, intravenous lidocaine can be administered for 2 weeks. We hope that our proposed drug treatment algorithm to control CRPS pain will help clinicians appropriately treat patients with CRPS. Further clinical studies assessing patients with CRPS are warranted to establish this treatment algorithm in clinical practice.http://www.e-jyms.org/upload/pdf/jyms-2023-00360.pdfcomplex regional pain syndromesmultimodalneuropathic painreflex sympathetic dystrophy |
| spellingShingle | Min Cheol Chang Donghwi Park Algorithm for multimodal medication therapy in patients with complex regional pain syndrome Journal of Yeungnam Medical Science complex regional pain syndromes multimodal neuropathic pain reflex sympathetic dystrophy |
| title | Algorithm for multimodal medication therapy in patients with complex regional pain syndrome |
| title_full | Algorithm for multimodal medication therapy in patients with complex regional pain syndrome |
| title_fullStr | Algorithm for multimodal medication therapy in patients with complex regional pain syndrome |
| title_full_unstemmed | Algorithm for multimodal medication therapy in patients with complex regional pain syndrome |
| title_short | Algorithm for multimodal medication therapy in patients with complex regional pain syndrome |
| title_sort | algorithm for multimodal medication therapy in patients with complex regional pain syndrome |
| topic | complex regional pain syndromes multimodal neuropathic pain reflex sympathetic dystrophy |
| url | http://www.e-jyms.org/upload/pdf/jyms-2023-00360.pdf |
| work_keys_str_mv | AT mincheolchang algorithmformultimodalmedicationtherapyinpatientswithcomplexregionalpainsyndrome AT donghwipark algorithmformultimodalmedicationtherapyinpatientswithcomplexregionalpainsyndrome |