WHAT ARE THE RECENT DEVELOPMENTS MADE IN THE TREATMENT OF CRPS ?
A 2
1 Limb trauma, such as a fracture and then having the limb placed in a cast, is a common cause of CRPS.
2 Children and adolescents with CRPS generally have a better recovery than adults and offer a unique model for the study of chronic pain reversal.
3 There are two similar forms, called CRPS-I and CRPS-II, with the same symptoms and treatments.
4 CRPS-II (previously called causalgia) is the term used for patients with confirmed nerve injuries.
5 Individuals without confirmed nerve injury are classified as having CRPS-I (previously called reflex sympathetic dystrophy syndrome)
6 It can strike at any age and affects both men and women, although it is much more common in women.
7 The average age of affected individuals is about age 40.
8 CRPS is rare in the elderly.
9 Children do not get it before age 5 and only very rarely before age 10, but it is not uncommon in teenagers.
Corticosteroids - only useful in acute phase
SympAthetic nerve block only temporary in 50 % , permanent - 50 % - should be followed by sympathectomy in responsive individuals
10 for CRPS is most effective when applied in a cohesive multidisciplinary venue.
11 The treating physician should be aggressive with medical therapies, systematically experimenting with opportunistic pharmaceutical approaches to eliminate the patient’s pain.
12 If the pain and other CRPS symptoms evade satisfactory treatment, then alternative or additional medications should be considered.
13 All treatments work best when applied early, and early-stage CRPS is easier to treat as well.
14 First-line analgesics and coanalgesics for CRPS are opioids, tricyclic antidepressants, gabapentin (or pregabalin), and carbamazepine.
15 In addition, a course of corticosteroids can be considered if inflammatory signs and symptoms predominate.
16 Sympatholytic procedures, such as sympathetic ganglion blocks, help identify the central pain component maintained by the SNS.
17 Calcium-regulating agents and gabapentoids have been shown to help with acute refractory neuropathic pain.
18 For intractable cases, SCS, IV ketamine, hyperbaric oxygen therapy (HBOT), and epidural clonidine should be strongly considered, especially SCS.
19 psychological therapies that include stress management, supportive psychotherapy, and the treatment of psychological comorbidities should also be initiated early as an integral component of the multidisciplinary approach. Psychological treatments, including cognitive behavioral therapies, are frequently used strategies.
20 Identifying an individual’s coping style and then reinforcing healthy coping behaviors; discovering contributing environmental or operant factors; and determining, then treating, associated emotional states are often necessary for steering a chronic pain process to a successful outcome.
HOW TO AVOID
REGIONAL ANESTHESIA SHOULD BE PREFERRED THAN GENERAL -
1 by allowing the preoperative onset of sympathetic blockade, may be a more appropriate anesthetic choice for patients with sympathetically maintained pain because it may prevent the recurrence of this syndrome in the postoperative period
2 The regional techniques used were epidural anesthesia for lower extremity surgery and brachial plexus blockade for upper extremity surgery.
3 It is important to realize that both of these regional techniques are associated with the preoperative onset of a sympathetic blockade, which could prevent the development of CRPS.
4 The use of stellate ganglion block, intravenous regional block, and epidural block have all been reported as techniques that may be useful in decreasing the incidence of postoperative CRPS.
So latest research is in favour of stellate ganglion blocks in upper limb surgeries
5 The regional sympatholysis provided by a stellate ganglion block may benefit CRPS patients who require hand surgery but it requires clinical expertise and may result in significant morbidity, including vertebral artery injection, subarachnoid or epidural block, and pneumothorax.
6 Further, stellate ganglion blocks frequently do not produce complete sympathetic interruption of the ipsilateral upper extremity.43 We believe intravenous regional blocks with clonidine may offer an advantage in the perioperative treatment of patients with CRPS
7 ROLE OF VIT C AS A ADD ON IN UPPERLIMB FRACTURES FOR 50 DAYS PREVENTS 3 TO 5 TIMES THE DEVELOPMENT OF CRPS IN A LATEST RESEARCH ( Q TO BE ASKED )
LATEST RESEARCH TO BE DONE ARE …
Emerging treatments for CRPS include -
1 Intravenous immunoglobulin (IVIG) - interfers with the anti neural antibodies which are seen in individuals with CRPS
A ) Researchers in Great Britain reported that low-dose IVIG reduced pain intensity in a small trial of 13 patients with CRPS for 6 to 30 months who did not respond well to other treatments.
B ) Those who received IVIG had a greater decrease in pain scores than those receiving saline during the following 14 days after infusion.
C ) A larger study involving individuals with acute-phase CRPS is planned.
D ). Patients with CRPS are more likely than healthy persons to show evidence of cytokines and other proinflammatory markers in tissue fluids, including cerebrospinal fluid.
E ) So , the immune system helps CRPS. Pain is not only dependent on the neurons that transmit it, but probably also on microglia and astrocytes, which make cytokines and stimulate pain processing
2 Ketamine. Investigators are using low doses of ketamine—a strong anesthetic—given intravenously for several days to either reduce substantially or eliminate the chronic pain of CRPS.
In certain clinical settings, ketamine has been shown to be useful in treating pain that does not respond well to other treatments.
3 Hyperbaric oxygen.
A ) Several studies have investigated the use of hyperbaric oxygen therapy for chronic pain.
B ) Individuals lie down in a tank containing pressurized air, which delivers more oxygen to the body’s organs and tissues.
C ) Although research is still experimental, some researchers report hyperbaric oxygen can reduce swelling and pain, and improve range of motion in individuals with CRPS.