COMPLEX REGIONAL PAIN SYNDROMES - GUIDELINES FOR THERAPY

This report aims to present an orderly approach to the treatment of Ch ronic Regional Pain Syndrome (CRPS) types I and II through an algorith m. The central theme is functional restoration: a coordinated but prog ressive approach that introduces each of the treatment modalities need ed to achieve both remission and rehabilitation. Reaching objective an d measurable rehabilitation goals is an essential element. Specific ex ercise therapy to reestablish function after musculoskeletal injury is central to this functional restoration. Its application to CRPS is mo re contingent on varying rates of progress that characterize the resto ration of function in patients with CRPS. Also, the various modalities that may be used, including analgesia by pharmacologic means or regio nal anesthesia or the use of neuromodulation, behavioral management, a nd the qualitatively different approaches that are unique to the manag ement of children with CRPS, are provided only to facilitate functiona l improvement in a stepwise but methodical manner. Patients with CRPS need an individual approach that requires extreme flexibility. This di stinguishes the management of these conditions from other well-describ ed medical conditions having a known pathophysiology. In particular, t he special biopsychosocial factors that are critical to achieving a su ccessful outcome are emphasized. This algorithm is a departure from th e contemporary heterogeneous approach to treatment of patients with CR PS. The underlying principles are motivation, mobilization, and desens itization facilitated by the relief of pain and the use of pharmacolog ic and interventional procedures to treat specific signs and symptoms. Self-management techniques are emphasized, and functional rehabilitat ion is the key to the success of this algorithm.