Complex regional pain syndrome treatment plans vary with each individual patient. There’s no cure, so treatment is aimed at reducing the painful symptoms that characterize the condition. The goal is to allow patients to lead normal lives and resume their usual activities.

A wide variety of treatments are available, including pharmaceuticals, surgery and physical therapy. Most patients are given a combination of options, which can be varied to find the best solution for their particular symptoms.

Medications. Several classes of drugs are used to control complex regional pain syndrome symptoms. Anti-inflammatories, antiseizure medications, corticosteroids and opiods are among those available, but unfortunately none of them has produced permanent effects. Topical analgesics such as lidocaine are also used to reduce painful nerves, skin and muscle tissue.

Intrathecal Drug Pumps. To reduce the amount of opioids and local anesthetic necessary to fight pain, a drug pump may be implanted to send drugs directly to the spinal fluid. The dose administered by the intrathecal drug pump is far lower than that needed with oral medication to achieve the same reduction in pain, and side-effects are reduced considerably.

Surgical Sympathectomy. Some patients in severe cases elect to undergo a surgical sympathectomy, which destroys the nerves related to CRPS. However, its use is controversial because some experts believe that it may worsen complex regional pain syndrome symptoms. The use of surgical sympathectomy is limited to those who obtain dramatic (though temporary) relief of their symptoms with selective sympathetic nerve blocks.

Sympathetic Nerve Block. Most patients should try getting a sympathetic block at least once, because they will experience drastic relief if their CRPS is related to the sympathetic nerves, which control blood vessel size, sweating, and many other functions. This family of nerve blocks includes stellate ganglion nerve blocks, lumbar sympathetic nerve blocks and Bier blocks. All of these involve the injection of a local anesthetic into the nerve. Alternatively, a phentolamine infusion may be given through an IV (into a vein). The effect is thought to mimic that of the blocks.

Spinal Cord Stimulation. Leads are surgically implanted along the spine, where stimulating electrodes induce a pleasant tingling sensation in the painful area. The patient has a remote control device to adjust the area and intensity of the effect.

Physical Therapy. The first step a therapist takes may be to manage edema with any one of a number of garments and manual mobilization techniques. Depending on the particular patient, the therapist may then need to use desensitization techniques on the affected area(s). Stress loading can be used to encourage active movement and joint compression. Movement is also the goal of graded motor imagery, including mirror therapy.

Psychotherapy. A secondary effect of complex regional pain syndrome involves depression, anxiety, and/or post-traumatic stress syndrome. It can become a vicious cycle when pain causes anxiety, and the anxiety worsens the pain. Other family members may benefit from treatment as well.