Complex regional pain syndromes: Guidelines for therapy

Michael Stanton-Hicks*, Ralf Baron, Robert Boas, Torsten Gordh, Norman Harden, Nelson Hendler, Martin Koltzenburg, Prithvi Raj, Robert Wilder

*Corresponding author for this work

Research output: Contribution to journalArticle

271 Scopus citations

Abstract

This report aims to present an orderly approach to the treatment of Chronic Regional Pain Syndrome (CRPS) types I and II through an algorithm. The central theme is functional restoration: a coordinated but progressive approach that introduces each of the treatment modalities needed to achieve both remission and rehabilitation. Reaching objective and measurable rehabilitation goals is an essential element. Specific exercise therapy to reestablish function after musculoskeletal injury is central to this functional restoration. Its application to CRPS is more contingent on varying rates of progress that characterize the restoration of function in patients with CRPS. Also, the various modalities that may be used, including analgesia by pharmacologic means or regional anesthesia or the use of neuromodulation, behavioral management, and the qualitatively different approaches that are unique to the management of children with CRPS, are provided only to facilitate functional improvement in a stepwise but methodical manner. Patients with CRPS need an individual approach that requires extreme flexibility. This distinguishes the management of these conditions from other well-described medical conditions having a known pathophysiology. In particular, the special biopsychosocial factors that are critical to achieving a successful outcome are emphasized. This algorithm is a departure from the contemporary heterogeneous approach to treatment of patients with CRPS. The underlying principles are motivation, mobilization, and desensitization facilitated by the relief of pain and the use of pharmacologic and interventional procedures to treat specific signs and symptoms. Self-management techniques are emphasized, and functional rehabilitation is the key to the success of this algorithm.

Original languageEnglish (US)
Pages (from-to)155-166
Number of pages12
JournalClinical Journal of Pain
Volume14
Issue number2
DOIs
StatePublished - Jun 23 1998

Keywords

  • Causalgia
  • Complex Regional Pain Syndrome (CRPS) types I and II
  • Reflex sympathetic dystrophy
  • Treatment algorithm

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine

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    Stanton-Hicks, M., Baron, R., Boas, R., Gordh, T., Harden, N., Hendler, N., Koltzenburg, M., Raj, P., & Wilder, R. (1998). Complex regional pain syndromes: Guidelines for therapy. Clinical Journal of Pain, 14(2), 155-166. https://doi.org/10.1097/00002508-199806000-00012