Treatment. CRPS/RSD/Causalgia

Complex regional pain syndrome diagnosis

Your doctor may familiarize with your medical history and perform a physical examination in order to make a CRPS diagnosis. Although there is no single test that can confirm CRPS diagnosis, specific procedures may help the doctor make a diagnosis. Such procedures include:

• X-rays. X-rays may reveal the loss of minerals from your bones in the later stages of the disease.
• Sweat production tests. Specific tests are used to measure the amount of sweat on both your limbs. Uneven results of such tests may reveal complex regional pain syndrome. 
• A bone scan may help the doctor to identify bone changes. To perform this procedure, the radioactive substance is injected into your vein. This allows the doctor to see your bones with a special camera.
• Magnetic resonance imaging (MRI). MRI test may show the changes in tissue that may cause complex regional pain syndrome.

Complex regional pain syndrome treatment

Evidence suggests that treatment in the early stages may help improve CRPS symptoms. However, it is necessary to apply the combination of treatment methods tailored for your case.

Medicines as a complex regional pain syndrome

• Pain relievers. Aspirin, ibuprofen, naproxen sodium, and some other over-the-counter pain relievers may improve the pain and inflammation. However, if over-the-counter pain relievers won’t be helpful, your doctor may prescribe stronger pain relievers, such as opioid medications.
• Sympathetic nerve-blocking medication. Injections of an anesthetic in order to block pain fibers in the affected nerves may help improve the pain in some cases.
• Antidepressants and anticonvulsants. Certain antidepressants, including anticonvulsants and amitriptyline, can be beneficial in treating the pain caused by nerve damage (neuropathic pain).
• Bone-loss medications. Your doctor may prescribe such medicines as alendronate and calcitonin to prevent or stall the process of bone loss.
• Corticosteroids. Steroid medicines, including prednisone, can help in reducing inflammation and improve mobility of the affected limb.
• Intravenous ketamine. Evidence suggests that low doses of intravenous ketamine (a strong anesthetic) may gradually ease the pain.

Therapies as complex regional pain syndrome treatment

• Physical or occupational therapy. Gentle exercising of the affected limbs under the control of specialists or daily activities may reduce pain and improve strength and range of motion. Exercises are most effective in the early stages of the disease.
• Transcutaneous electrical nerve stimulation (TENS). Applied electrical impulses to nerve endings may ease chronic pain.
• Heat therapy. Heat application may relieve swelling and unpleasant sensations on skin that feels cool.
• Mirror therapy. This therapy uses a mirror in order to trick the brain. This procedure involves sitting before a mirror or mirror box and moving the healthy limb. In this way, the brain will perceive the moving limb as affected by the CRPS limb. As evidence suggests, this therapy may help in improving function and reducing pain caused by CRPS.
• Intrathecal drug pumps. During this treatment, a medication that relieves pain is injected into the spinal cord fluid.
• Biofeedback. Biofeedback helps you understand your body better to learn how to relax your body and relieve pain.
• Spinal cord stimulation. To perform this procedure, your doctor may insert tiny electrodes along your spinal cord so that a slight electrical current is delivered to the spinal cord to relieve pain.
• Topical analgesics. Certain topical treatments may help in reducing hypersensitivity. Such treatments include over-the-counter capsaicin cream, lidocaine cream, or specific patches.
• Acupuncture. In this procedure, nerves, muscles, and connective tissue are stimulated by the insertion of long, thin needles to increase blood flow and relieve pain.