Complex regional pain syndrome (CRPS), previously known as
reflex sympathetic dystrophy and
causalgia, is a clinical entity characterized by classic
neuropathic pain, autonomic involvement, motor symptoms, and trophic changes in the skin, nails, and hair. Although various therapeutic modalities are used to control CRPS-related
pain, severe
pain due to CRPS often persists and progresses to the chronic phase. In this study, we constructed an algorithm for multimodal medication
therapy for CRPS based on the established pathology of CRPS. Oral
steroid pulse
therapy is recommended for initial
pain management in patients with CRPS. Oral
steroid therapy can reduce peripheral and central
neuroinflammation, contributing to the development of
neuropathic pain during the acute and chronic phases. If
steroid pulse
therapy offers poor relief or is ineffective, treatment to control central sensitization in the chronic phase should be initiated. If
pain persists despite all
drug adjustments,
ketamine with
midazolam 2 mg before and after
ketamine injection can be administered intravenously to inhibit the
N-methyl D-aspartate receptor. If this treatment fails to achieve sufficient efficacy, intravenous
lidocaine can be administered for 2 weeks. We hope that our proposed
drug treatment algorithm to control CRPS
pain will help clinicians appropriately treat patients with CRPS. Further clinical studies assessing patients with CRPS are warranted to establish this treatment algorithm in clinical practice.