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A 46-year-old female asked:

Crps after injury/surgery. pain dr- mild but will take time. does it worsen without treatment? options- nerve blocks, medication, physio- what's best?

1 doctor answer1 doctor weighed in
Dr. Dimitri Novitzky
Thoracic Surgery 54 years experience
CPRS, AND PAIN: Complex Regional Pain Syndrome, or CRPS, formerly known as RSD or Reflex Sympathetic Dystrophy is a progressive disease of the Autonomic Nervous System, and more specifically, the Sympathetic Nervous System. The pain is characterized as constant, extremely intense, and out of proportion to the original injury. The pain is typically accompanied by swelling, skin changes, are extreme sensitivity. Treatment for CRPS, which usually includes a combination of physical therapy (physiotherapy) and medications, is much more effective if it starts soon after the onset of symptoms. As the condition is very difficult to diagnose, it is not possible to make reliable estimates of the number of people affected. A significant number of patients never tell their GP (general practitioner, primary care physician) or doctor if their symptoms are mild. The National Health Service (NHS), UK, believes that approximately 1 in every 2,000 accidents or incidents of trauma probably result in CRPS. Although CRPS can affect people of any age, first symptoms tend to become noticeable in patients aged between 40 and 60 years. Experts say that more females are affected than males. The severity of symptoms and frequency of episodes of CRPS vary enormously. Some individuals have repeated CRPS episodes throughout their life, while others have symptoms which go away forever after a few months. Pain relievers. Over-the-counter (OTC) pain relievers — such as aspirin, ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve) — may ease pain and inflammation. Your doctor may prescribe stronger pain relievers if OTC ones aren't helpful. Opioid medications may be an option. Taken in appropriate doses, they may provide acceptable control of pain. Antidepressants and anticonvulsants. Sometimes antidepressants, such as amitriptyline, and anticonvulsants, such as gabapentin (Gralise, Neurontin), are used to treat pain that originates from a damaged nerve (neuropathic pain). Corticosteroids. Steroid medications, such as prednisone, may reduce inflammation and improve mobility in the affected limb. Bone-loss medications. Your doctor may suggest medications to prevent or stall bone loss, such as alendronate (Fosamax) and calcitonin (Miacalcin). Sympathetic nerve-blocking medication. Injection of an anesthetic to block pain fibers in your affected nerves may relieve pain in some people. Intravenous ketamine. Studies show that low doses of intravenous ketamine, a strong anesthetic, may substantially alleviate pain. However, despite pain relief, there was no improvement in function.
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Last updated Apr 14, 2017

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