Posted on Feb 24, 2009

Treatments and drugs Dramatic improvement and even remission of complex regional pain syndrome is possible if treatment begins within a few months of your first symptoms. Treatment options include: Medications. Doctors use various medications to treat the symptoms of complex regional pain syndrome. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen (Advil, Motrin, others) and naproxen sodium (Aleve), may ease pain and inflammation. In some cases, doctors may recommend prescription medications. For example, antidepressants such as amitriptyline and anticonvulsants such as gabapentin (Neurontin) are used to treat pain that originates from a damaged nerve (neuropathic pain). Corticosteroids, such as prednisone, may reduce inflammation. Your doctor may suggest bone-loss medications, such as alendronate (Fosamax) and calcitonin (Miacalcin). Opioid medications may be another option. Taken in appropriate doses, they may provide acceptable control of pain. However, they may not be appropriate if you have a history of substance abuse or lung disease. Some pain medications, such as COX-2 inhibitors (Celebrex), may increase your risk of heart attack and stroke. It's wise to discuss your individual risk profile with your doctor. Applying heat and cold. Applying cold may relieve swelling and sweating. If the affected area is cool, applying heat may offer relief. Capsaicin. This cream, made from the seeds of hot chili peppers, may relieve pain caused by nerve damage in early-stage complex regional pain syndrome. Your doctor may recommend applying the cream to the affected area several times daily. Capsaicin cream can be very irritating if rubbed on nonaffected parts of your body. Follow the application instructions carefully. You should be able to tell within a week whether the treatment is effective and tolerable. Physical therapy. Gentle, guided exercising of the affected limbs may improve range of motion and strength. The earlier the disease is diagnosed, the more effective exercises may be. Sympathetic nerve-blocking medication. Injection of an anesthetic to block pain fibers in your affected nerves may relieve pain in some people. Transcutaneous electrical nerve stimulation (TENS). Chronic pain is sometimes eased by applying electrical impulses to nerve endings. Biofeedback. In some cases, learning biofeedback techniques may help. In biofeedback, you learn to become more aware of your body so that you can relax your body and relieve pain. Spinal cord stimulation. Your doctor inserts tiny electrodes along your spinal cord. A small electrical current delivered to the spinal cord sometimes results in pain relief. CRPS Medications NonSteroidal Anti-Inflammatory Drugs (NSAIDs): Aspirin (Ecotrin, ASA) Diclofenac (Voltaren) Diflunisal (Dolobid) Celecoxib (Celebrex - a cox-2 inhibitor) Etodolac (Lodine) Ibuprofin (Advil, Nuprin, Motrin, etc.) Indomethacin (Indocin) Ketorolac (Toradol (only use for up to five days.)) Oxaprozin (Daypro) Piroxicam (Feldene) Sulindac (Clinoril) Opioid-Like Drugs (Narcotics): Butorphanol Tartrate (Stadol) Nalbuphine (Nubain) Pentazocine Lactate (Talwin) (a category of drugs called opioid agonist-antagonists. They  probably should not ever be used.) Codeine Phosphate (Codeine) Fentanyl Citrate (Fentanyl) Hydromorphone (Dilaudid) Morphine Sulfate (MS Contin, Noxamol) Oxycodone (Oxyir, Roxicodone, Oxycontin, Percocet) Buprenorphine (Subutex, Suboxone) Propoxyphene Napsylate (Darvon – N) Methodone Hydrocodone (Vicodin) Opioid – Containing Combination Drugs: Hydrocodone/Acetaminophen (Anexsia) Propoxyphene/APAP (Darvocet) Butalbital/ASA/Caffiene/Codiene (Fiorinal with Codeine) Butalbital/APAP/Caffiene/Codiene (Fioricet with Codeine) Hydrocodne/Acetaminophen (Lortab) Hydrocodone/APAP (Norco) Oxycodone/Aspirin (Percodan) Hydrocodone/Acetaminophen (Lorcet) Carisoprodol plus Codeine (Soma with Codeine) Oxycodone/Acetaminophen (Tylox) Hydrocodone/Acetaminophen (Vicodin) Hydrocodone/Ibuprofen (Vicoprofen) Other Analgesics: Acetaminophen (Tylenol, Panadol, Tempra, etc.) Tramadol (Ultram) Anesthetics/Sedatives: Fentanyl Citrate (Fentanyl) Ketamine (Ketalar) Diphenhydramine (Sufentanil, Sleepinal) Local Anesthetics: Bupivacaine (Marcaine, Bupivac) Lidocaine (Xylocaine) Mepivacaine (Carbocain) Anxiolytics/Hypnotics (used when anxiety disorders and/or sleep disturbance is present): Lorazepam (Ativan) Temazepam (Restoril) Alprazolam (Xanax) Midazolam Hydrochloride (Versed) Oxzaepam (Serax) Diphenhydramine Hydrochloride (Benadryl) Chlordiazepoxide (Librium) Clonazepam (Klonopin) Clorazepate Dispotassium (Tranxene) Flurazepam (Dalmane) Buspirone (Buspar) Zolpidem (Ambien) Zaleplon (Sonata) Eszopiclone (Lunesta) Anti-epileptics (Anticonvulsants): Carbamazepine (Tegretol) Clonazepam (Klonopin) Topiramate (Topomax) Gabapentin (Neurontin) Phenytoin (Dilantin) Valproic Acid (Depakene/Depakote) Tiagabine (Gabitril) Pregabalin (Lyrica) Diazepam (Valium) Lamotrigine (Lamictal) Levetiracetam (Keppsa) Oxcarbazepine (Trileptal) Pregabalin is related to gabapentin and is approved to treat neuropathic pain, specifically diabetic peripheral neuropathy and postherpetic neuralgia. It is currently under review by the FDA for the adjunctive treatment of partial seizures and may have potential for treating CRPS. Anti-depressants: Fluoxentine Hydrochloride (Prozac) Paroxetine (Paxil) Sertraline Hydrochloride (Zoloft) Amitriptyline (Elavil) Desipramine (Norpramin) Venlafaxine (Effexor) Doxepin (Sinequan) Bupropion Hydrochloride (Wellbutrin) Nefazodone (Serzone) Trazadone (Desyrel)   Muscle Relaxants Baclofen (Lioresal) Carisoprodol (Soma) Methocarbamol (Robaxin) Tizanidine (Zanaflex) Cyclobenzaprine (Flexeril) Dantrolene Sodium (Dantrium) Diazepam (Valium) Quinine Sulfate (Quinaam) Trans-dermal Patches and Ointments May Contain: Catapres (Clonidine) Ketamine (Ketalar) Capsaicin (Zostrix) Fentanyl Citrate (Fentanyl - local anesthetic) Combinations of drugs used for transdermal or intra-spinal use often are made by a process called compounding. Just a few select pharmacists make such medications.