Your favorite CRPS meds?

[specepic]

What, if any, meds are your go to options for CRPS pts?

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[willabeast]

Steroids (oral prednisone) are extremely helpful early on in CRPS.
Prednisone for Acute Complex Regional Pain Syndrome: A Retrospective Cohort Study

 

[Ferrismonk]

In general, if there are a bunch of meds available to treat something, then nothing works well. This is my experience with CRPS.

PT, OT, pain psych, +/- gabapentin/Lyrica, maybe Clonidine patch. Maybe sympathetic NB, maybe SCS depending.

 

[jwalker12]

Lidocaine ointment to help with desensitization

 

[MitchLevi]

Baclofen and topirimate, the other meds we all use too.

 

[claire_inet21]

Hello! I’m currently an M1 but I do have CRPS, I was diagnosed at 15 years old in 2014. Im currently 23 and I’ve found what helps me best is an electrode device called a “Quell” that I wear around one knee during my flare ups. It connects to my phone via Bluetooth and provides electrical stimulation therapy on for one hour then off for one hour throughout the day. Steroids helped me originally on the beginning when I was going through the diagnosis process, but now 8 years in, my Quell helps me the most

 

[specepic]

In general, if there are a bunch of meds available to treat something, then nothing works well. This is my experience with CRPS.

PT, OT, pain psych, +/- gabapentin/Lyrica, maybe Clonidine patch. Maybe sympathetic NB, maybe SCS depending.

same

 

[specepic]

Doing my LA questions this a.m. and the right answer, per ABPMR or ABA (I don't remember which site I was on) was:

calcitonin (other options were baclofen, NSAID, opioid)

 

[callmeanesthesia]

Hello! I’m currently an M1 but I do have CRPS, I was diagnosed at 15 years old in 2014. Im currently 23 and I’ve found what helps me best is an electrode device called a “Quell” that I wear around one knee during my flare ups. It connects to my phone via Bluetooth and provides electrical stimulation therapy on for one hour then off for one hour throughout the day. Steroids helped me originally on the beginning when I was going through the diagnosis process, but now 8 years in, my Quell helps me the most

I’ve heard of those - sort of like a fancy TENS? If I may ask, how much did it cost and did insurance cover it for you? I’m in an Ortho group so if it’s cost-effective something like that might be nice to help people in the acute phase get the pain under control so they can do PT more effectively.
Regarding the original question, for acute CRPS, PT, PT, PT, and diligent home performance of desensitization exercises. Anti-neuropathic meds to support that but counseling that they are nothing but a band-aid.

 

[TIVAndy]

i've started bisphosphonates also recently after reading some studies. anyone else use it?

 

[PainApp2021]

For pharmacologic refractory, lidocaine/ketamine infusions, memantine, LSB/stellate, SCS

 

[Ligament]

i've started bisphosphonates also recently after reading some studies. anyone else use it?

I remember when this was a kinda new thing about 13 years ago...has nothing new surfaced since biphosphonates? Our field has really stagnated with pain meds for the past decade+

 

[GoBeers]

anyone ever try brachial plexus block for CRPS of upper extremity? PNS to brachial plexus?

 

[DOctorJay]

anyone ever try brachial plexus block for CRPS of upper extremity? PNS to brachial plexus?

not brachial plexus, but in training at Mayo we were doing peri-arterial blocks in the forearm under ultrasound in the hand clinic. it's been a long time since I've seen an upper extremity CRPS patient so I haven't done any of these in practice.

 

[Orin]

anyone ever try brachial plexus block for CRPS of upper extremity? PNS to brachial plexus?

Yeah, I'll drop a PNS lead there intermittently, but I would much rather to do a cervical SCS.

 

[HyperSonic]

anyone ever try brachial plexus block for CRPS of upper extremity? PNS to brachial plexus?

I tried supraclavicular and interscalene plexus blocks. Sometimes they work better than stellate ganglion blocks. I was using peripheral nerve stimulators at these locations if block did not last.

 

[TIVAndy]

anyone ever try brachial plexus block for CRPS of upper extremity? PNS to brachial plexus?

i have a few cases with some success - i'm trying to publish a case series for it.

 

[Norepi]

I tried supraclavicular and interscalene plexus blocks. Sometimes they work better than stellate ganglion blocks. I was using peripheral nerve stimulators at these locations if block did not last.

What was your experience with PNS here?

 

[painfree23]

I tried supraclavicular and interscalene plexus blocks. Sometimes they work better than stellate ganglion blocks. I was using peripheral nerve stimulators at these locations if block did not last.

Do u do this in office? What do u inject?

 

[Baron Samedi]

I've had some decent experience with ketamine infusions paired with Physical Therapy if you catch them early on in the disease course.

A while back I had a Navy Academy student develop CRPS after a sprained ankle and rapidly developed allodynia, vasomotor changes, and atrophy. She couldn't tolerate wearing a sock and certainly couldn't bear weight or meaningfully participate in therapy. We admitted her for a 5 day ketamine(0.5 mg/kr/hr) and paired it with daily PT. By the end of the week she was bearing weight and able to proceed with outpatient PT. I saw her for follow-up a couple months later and she was able to do single leg calf raises on the affected foot. It saved her career.

Have had similar successes with outpatient infusions but to a lesser extent. Obviously the ability to do this is highly limited by your practice setting.

 

[epidural man]

i've started bisphosphonates also recently after reading some studies. anyone else use it?

The studies on this are great! You read them and think - holy COW, this is the ticket!

And then you try it and it doesn't work. You think - well shucks, it is just one patient.

Then you try it again, and again- it doesn't work. You do that 5 more times, and eventually, you start to think...wow, these meds suck for CRPS.

 

[epidural man]

I have tried low dose Naltrexone.

All CRPS patients get Vit C.

Also, gabapentin doesn't work. Lryica might.

Best is graded motor imagery. Find a PT that can do that.

Then SCS.

 

[bedrock]

I have tried low dose Naltrexone.

All CRPS patients get Vit C.

Also, gabapentin doesn't work. Lryica might.

Best is graded motor imagery. Find a PT that can do that.

Then SCS.

no sympathetic blocks ?

 

[epidural man]

OH, I voted for Calcitonin. I think it works sometimes.

But I have seen it work really great for acute PLP.

 

[epidural man]

no sympathetic blocks ?

oh yes - I'll do those.

 

[TIVAndy]

I have tried low dose Naltrexone.

All CRPS patients get Vit C.

Also, gabapentin doesn't work. Lryica might.

Best is graded motor imagery. Find a PT that can do that.

Then SCS.

isn't vit c more for prophylaxis - decrease incidence of crps?

 

[lobelsteve]

isn't vit c more for prophylaxis - decrease incidence of crps?

Hip replacement data in existing CRPS. 50 days of high dose Vit C. 2 weeks before, 4 weeks after surgery.
I tell all my CRPS pts to take 5 Vit C per day for this 6 week period. No harm.

 

[oreosandsake]

not brachial plexus, but in training at Mayo we were doing peri-arterial blocks in the forearm under ultrasound in the hand clinic. it's been a long time since I've seen an upper extremity CRPS patient so I haven't done any of these in practice.

👍🏼
Vaso vasorum, Nervi nevorum

Don’t need to do entire BP block to get good relief.

I do a lot of PNBs in office for CRPS and “CRPS” look alike after trauma or foot ankle injuries.

I’ve found them to be much more helpful than sympathetic blocks which can have higher risk or require fluoroscopy

 

[oreosandsake]

Doing my LA questions this a.m. and the right answer, per ABPMR or ABA (I don't remember which site I was on) was:

calcitonin (other options were baclofen, NSAID, opioid)

Funny how these board Qs always ask for the answer that no one really uses

Triple phase bone scans, calcitonin or bisphosphanates.

Norm Harden a non interventionalist and Stanton Hicks were my mentors. We never ever used this stuff or ordered these tests

 

[painfree23]

👍🏼
Vaso vasorum, Nervi nevorum

Don’t need to do entire BP block to get good relief.

I do a lot of PNBs in office for CRPS and “CRPS” look alike after trauma or foot ankle injuries.

I’ve found them to be much more helpful than sympathetic blocks which can have higher risk or require fluoroscopy

Can u give an example of a PBB u do for lower extremity? How much do u inject?

 

[oreosandsake]

Can u give an example of a PBB u do for lower extremity? How much do u inject?

popliteal sciatic. tibial or common peroneal. if there is specific distribution in peripheral nerve I will hydrodissect around the nerve... superficial peroneal, sural, etc.

Charles Olivera, a great brazilian pain doctor once gave a talk where he said, we call it crps type 1 and type 2. what if it's all type 2 and we just never figured out where the lesion was? he gave a great talk where the place the nerve was injured was identified under US.

learning how to trace peripheral nerves with US you can often identify exactly where the nerve is injured. I inject bupivicaine, itypically diluted with PFNS, +/- dexamethasone. you can hydrodissect with Dextrose 5% as well.

 

[ctts]

Do you have any thoughts on calcium channel blockers to address vasomotor symptoms? Especially cold extremities? And in chronic versus acute CRPS?