Management of complex regional pain syndrome of the hand

Abstract

Downloadable open access UK guidelines for managing complex regional pain syndrome (CRPS) have been available since 2012. Care is interdisciplinary and readers involved in the care of patients with CRPS are strongly recommended to read these guidelines. Since 2012 there have been several larger randomized controlled trials (RCTs) which have helped to clarify the role of some treatments in CRPS management, although the results of some subsequent meta-analyses have been conflicting. Early data from an RCT with 152 patients suggest superiority of dorsal root ganglion stimulation over conventional spinal cord stimulation in patients with lower extremity CRPS. An RCT involving 111 patients investigating the role of low-dose intravenous immunoglobulin treatment in long-standing CRPS failed to show benefit from this treatment. Despite the lack of direct evidence that nociceptive and neuropathic pain drugs can relieve pain from CRPS, it is reasonable for orthopaedic surgeons to follow relevant guidelines and initiate treatment with these drugs and to request GP colleagues to monitor and titrate these drugs as appropriate. As per the UK CRPS guidelines, the non-surgical approach to the management of CRPS centres on the following four pillars of care: education, physical rehabilitation, pain relief and psychological intervention where appropriate.