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Specialist CRPS and Chronic Pain Solicitor Andrew Atkinson considers the wide range of therapies and treatments available for CRPS and their effectiveness.Visit our main CRPS Compensation page.
Treatments for CRPS
Currently, there’s no cure for CRPS [See: Do people recover from CRPS?], although the Royal College of Physicians has published clinical guidelines on diagnosis and management. As with so many conditions, a late diagnosis means that therapies and treatments for CRPS that may have proved beneficial early on are less likely to be so once the condition is well established.
Medication
Medication proves beneficial in less than two-thirds of CRPS sufferers, and achieving an effective and workable balance of medication is challenging. In general terms, the more potent the drug, the greater the side effects, particularly mentally. Reducing pain often comes at the cost of fatigue and poor concentration, memory, and reaction time.
Among the most common drugs in the CRPS armoury are:
- Non-Steroidal Anti-Inflammatory Drugs (NSAIDs). Although unlikely to benefit the pain of CRPS, NSAIDs are often recommended before diagnosis.
- Anticonvulsants. In addition to epilepsy, doctors prescribe Pregabalin and Gabapentin for severe neuropathic pain, but often at the cost of significant cognitive side effects.
- Tricyclic Antidepressants. Amitriptyline or Nortriptyline are often prescribed to chronic pain sufferers as they can also be beneficial for nerve pain. One side benefit is their ability to aid sleep.
- Opiates. Doctors administer Buprenorphine (similar to Morphine) as skin patches, and some CRPS sufferers receive Morphine itself as Oramorph solution.
Sympathetic Nerve Blocks
Sympathetic nerve blocks can provide short-term relief from CRPS pain, although there is no evidence that they are an effective longer-term treatment.
Physical Therapies for CRPS
Physical therapies such as gentle exercise, weight-bearing, and hydrotherapy are common components of multi-disciplinary pain management programmes. Another commonly used therapy is Desensitisation. The technique aims to reduce sensitivity by focusing on how different materials feel against parts of the body unaffected by CRPS symptoms.
Graded Motor Imagery
Graded Motor Imagery is a long-established treatment for CRPS. Although encompassing several techniques, Mirror Box Therapy (MBT) is best known. In MBT, the equipment comprises a box incorporating a specially placed mirror. The idea is to trick the brain into thinking that the CRPS symptoms have disappeared using the person’s unaffected limb.
Self-Management
Relaxation techniques such as Yoga and Mindfulness and learning to pace yourself are invaluable skills.
Pain Management Programmes
The objective of pain management programmes is to turn existing with chronic pain into living with chronic pain. Approaches vary, but generally, a combination of treatments and therapies is tailored around the individual, drawing on the multi-disciplinary skills available. They often encompass pain medicine, physiotherapy, occupational therapy, and psychological therapy.
The pain clinic’s role might be summarised as supporting the patient in developing self-help skills to control and relieve pain. It’s hoped that these coping strategies will result in the patient experiencing an improvement in their quality of life.
Pain management programmes usually run on an outpatient basis, but a few centres, such as the Bath Centre for Pain Services, offer inpatient programmes. The advantage of an inpatient programme is that the patient and the multi-disciplinary team can focus entirely on developing coping strategies more intensively and for longer.
Spinal Cord Stimulation
For some chronic pain conditions, the implantation of a spinal cord stimulation (SCS) or a dorsal root ganglion stimulation (DRG) can help provide long-term pain relief. However, the procedure is invasive, requiring the insertion of electrodes near the spinal cord. In turn, the electrodes connect to a subcutaneous battery-powered device operated by a remote control.
The principle is relatively straightforward: the device delivers electronic signals to interrupt the pain signals travelling to the brain. Although most CRPS sufferers experience at least some benefits, the reported level of pain relief varies considerably.
Alternative Therapies
Some people find alternative therapies are effective for the short-term relief of symptoms. At the end of the day, it’s what works for the individual that counts. Over the years, my clients have reported benefits from therapies as diverse as reiki, acupuncture, and hypnotherapy. However, it’s always worth discussing complementary therapies with your treating clinicians. These days, many are more open-minded about them and may even be able to recommend practitioners.