A voyage in the treatment of CRPS
To develp a condition like Complex Regional Pain Syndrome it takes a moment, a life changing moment in which a person is called to a most difficult task. From that moment, a person will need to work hard to walk through the path of recovery wich is surely possible, as much as it can be challenging.
CRPS generally develops after a trauma which can result from various factors like a surgery (one of the most common causes), a fracture or broken bone. Not only, this condition frequently onsets after a minor trauma like a sprain or a distortion. A few weeks after the injury, the patient finds that the involved area is not healing like it should and, on the contrary, the whole situation seems to worsen.
This is probably the most important time and it is vital not to panic: CRPS, after all, is still a rare condition so the odds are on the person’s favor. When the pain is not exaggerated, it most likely is a much easier to manage condition: this syndrome usually has an initial acute phase and the pain should be overwhelming. Even when that is the case, it could be something else so, again, it is important not to panic.
The best way to obtain a correct diagnosis is to search for a second or even third opinion. Although CRPS is not an easy condition to diagnose, any specialist could correctly assess it. The physician should have familiarity with the Budapest Criteria and it could be the doctor visited by the patient after the original trauma. By being a condition that involves the neurological, muscular and skeletal system, a neurologist, a rheumatologist, a rehabilitation specialist can correctly diagnose CRPS. Having the same diagnosis from different specialists should allow a person to be sure enough of what is happening.
After the diagnose is confirmed, there really is one way to correctly treat this condition. Now, as we all know, Complex Regional Pain Syndrome is a very personal condition since it involves pain. This fact makes it necessary to form and create a therapy path built around the patient; there is no “standard” solution. Because of this, patients all over the world are told that they are facing a life-changing-incurable disease and that there is little hope for them to be better.
CRPS is life-changing, yes, but like many other things that happen in life, it is up to the single person to decide if the change is to the best or to the worse. The patient is forced into a better understanding of the self by being in an extreme situation in which one is called to stay calm and to understand every signal given by the body. Doctors can only offer to a patient what is available in their country and Health System. In this perspective it is vital for the doctors to understand their limits and to understand that the only way to treat this condition is a multidisciplinary approach.
Many doctors in many different countries like, for example, the USA, strongly rely on pharmaceutical treatments when not surgery. Unfortunately, because of the very personal nature of this condition, these types of treatments are not very succesful alone: the pain relief may vary from patient to patient, as well as the side effects, which could be severe. Surgery should only be considered by the patient in case there is an atrophy: by being one of the leading causes of CRPS, a surgical procedure (amputation of the affected limb in the most extreme cases) should really be considered after nothing else has been working with a huge risk of permamently compromising the situation.
There are some very common pharmaceuticals used for the treatment of CRPS: gabapentin is one of the most used drugs for this. Many patients get the wrong impression that, simply by taking such drugs, things will eventually improve on their own. Unfortunately, this could not be more distant from the truth: oppioids, corticosteroids, gabapentin are all very useful to take care of the initial acute phase but are not a reliable therapy alone. As a matter of fact, on the long term, such drugs could worsen the situation with terrible side effects like addictions, allucinations or, last but not least, will make the patient less responsive to them.
Time is a vital factor in the correct treatment of CRPS: this condition presents 3 phases and, while the atrophic phase can be a challenge to treat, the two initial ones are not as complicated. The pharmaceuticals we have mentioned above are very useful to treat the initial phase and, while they don’t represent a solution, they are propedeutic to the access of a correct rehabilitative program. In other words, these treatments will make the pain more manageable in order to make the patient ready for the rehabilitation.
Rehabilitation represents a fundamental aspect of the treatment of CRPS and a patient must undergo it as soon as it is possible. The condition usually shows an initial acute phase, which should be kept under control with minor pain management treatments so that the Osteopath or Physiotherapist will be able to perform the job. The aim here is to prevent the outburst of an actual dystrophy while improving the blood circulation in the affected area, this is why the Doctor and the physiotherapist will have to cooperate to prescribe a fitting therapy path, designed on the patient’s tollerability and clinical situation.
In the following couple of months, the patient will be constantly followed by doctors, who will be able to perform different minimally invasive options (like mirror therapy, massage therapy…). After this first moment the patient should be improving enough to start searching for the best solution possible. At this point, the patient will surely find that there is only one treatment available officially indicated for CRPS: Neridronate infusions. These infusions alone, can put the condition into remission but, when supported with the correct pain management and rehabilitation, they surely are the only available option.
Unfortunately, these infusions are currently available only in Italy and no equivalent drug has given the same result when used to treat this condition. Not only, this therapy path is the only one that has enough research to support its effectiveness. Other treatments may have shown promising results for specific cases but they all need further testing to be approved. In any case, other treatments only have to do with pain management, Neridronate on the other hand will locally regulate the cell cycle and calm the inflammatory reaction, attacking the source of the problem, rather than managing the effects.
Another therapy that has shown some very promising results, available and used in many countries but yet to be approved, is called Perineural Injection Therapy. This therapy will be very useful by rebuilding the damaged tissues but, like it happens with Neridronate, a patient should undergo it after the first, acute phase.
All together, this represents the best therapy path for the treatment of Complex Regional Pain Syndrome: with little to no pharmaceutical pain management, countries like Italy made huge leaps in the available therapies. A patient should know that solutions are available and that the best one is the one that involves the cooperation of different physicians from the very beginning, the diagnosis. Once the diagnosis is confirmed, patients should not panic and keep in mind that, in a global society, there are countries that offer full packages with everything that is needed for the correct treatment of this terrible condition.
Hopefully, CRPS will not be so scary anymore.
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