Patients often complain of the symptom of disturbed body perception
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50,000 new cases per year in the US
Tests not helpful (including xrays, MRIs, Nerve Conduction Tests)
The physician carefully taking a detailed history and performing a physical examination is the best diagnostic test
It is very important to Start immediately treating the condition
This is a syndrome typically treated by Pain Management Specialists (Physiatrists, Anesthesiologists, Neurologists)
Treatment is for restoring function, not pain reduction. The emphasis has to be on getting back a life lost with this incredible pain. True suffering occurs with CRPS.
PT must start below level of pain, then progress slowly and gradually.
What type of medications can help?
Glial Cell Attenuators are needed to calm down the inflammation in the Glia cells. Minocyline, propentofylline are glial cell attentuators that can help.
Opioids increase glial cell activity--patients taking opioids initially feel much improvement, then need more and more and more without gaining relief. Important to get CRPS patients off opioids.
Low dose naltrexone good 1 to 4.5 mg as a glial cell attenuator with little to no side effects
IV Ketamine is the main stay of invasive treatments
Many ways to administer, orally most side effects since have to take higher dose
Usually IV Ketamine in an Infusion center starting with low dose over a 4 hour period. The dose is gradually increased over 10 days. The effect is documented.
Booster at 2 weeks for 1-2 days and then at 4 and at 6 weeks
Patients should be given sublingual Ketamine for flare
Topical Ketamine only helps initially when the pain is just starting and not when gets into CNS (called centralization), yet it does help skin lesions that may develop at any time during the process
Nerve blocks low help, potential of harm
SCS (Spinal Cord Stimulators) are painful and expensive , 30% complications
Improve quality of life for 2 years only