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CRPS Pain Medications
These are agents that help counteract the condition's effect on the body.
Many categories of medication have been used with varying degrees of success.
These include analgesics (or pain-relievers) that affect the sympathetic
nervous system, anti-epileptic medications, a variety of drugs called "psychotropics"
that can alter mood and promote a feeling of well being, sleep aids, muscle
relaxants and steroids. Make sure that your
physician is thoroughly familiar with dose ranges, potential side effects, drug
interactions and the drug's probability of success. In the early stages of CRPS, drugs
alone are almost never a substitute for sympathetic blocks and limb
reactivation but can be useful aids in treatment. (See injections and surgery.) The selection of drugs depends upon several factors: Stage of the disorder; Whether active sympathetic symptoms are associated with the
pain; Severity of associated muscle problems, such as spasms, muscle
weakness and tremors; Severity and type of any associated emotional problems, such as panic,
anxiety, depression and sleep disturbances; Whether there is suspected nerve or central nervous
system lesion or injury; How experienced, knowledgeable and current your physician is about CRPS. Many drugs can be obtained
over-the-counter (OTC) and others are used in an "off-label" manner, meaning
that the drug may be used to treat a condition for which it was not originally
intended. An example of this is prescribing gabapentin (Neurontin), which
was originally marketed as an epilepsy drug, for the neuropathic
pain experienced by many CRPS patients. Gabapentin is widely used for
neuropathic pain conditions because of its efficacy, safety and relative lack
of side effects. Several studies conducted in a scientifically rigorous manner
show that gabapentin is effective in several neuropathic conditions, such as
post-herpetic neuralgia (nerve pain following an attack of shingles) and
diabetic neuropathy (nerve pain from diabetes).(Rowbotham et al, 1998; Backonja
M et al, 1998) The most common side effects—dizziness and sedation—usually can
be avoided by starting gabapentin at low doses and increasing the dose every
few days. Much higher doses may be needed for full effectiveness. Newer
anti-epileptic drugs such as pregabalin (Lyrica) also are showing promise for
the treatment of pain. Many other categories of drugs have been used with varying degrees
of success for CRPS. Assessing their usefulness is tricky for a variety
of reasons, including: Variability of doses and responses among patients;
Inadequate prescribing by poorly trained physicians;
Because information about medications used to treat CRPS is
constantly changing, the following list of medications is by no means
comprehensive. For more detailed information about medications used for
CRPS, refer to the Physicans' Desk Reference, 60th Edition,
2006, www.pdr.net. This is the resource most physicians use. Never use this
information to treat yourself. It is no substitute for the experience and
knowledge of your physician. Aspirin (Ecotrin, ASA) Opioid-Like Drugs (Narcotics):
Opioid – Containing Combination Drugs:
Other Analgesics:
Anesthetics/Sedatives:
Local Anesthetics:
Anxiolytics/Hypnotics (used when anxiety disorders and/or sleep disturbance is present):
Anti-epileptics (Anticonvulsants):
Pregabalin is related to gabapentin and is approved to treat neuropathic pain, specifically diabetic peripheral neuropathy and postherpetic neuralgia. It is currently under review by the FDA for the adjunctive treatment of partial seizures and may have potential for treating CRPS. Anti-depressants:
Muscle Relaxants
Trans-dermal Patches and Ointments May Contain:
Combinations of drugs used for transdermal or intra-spinal use often are made by a process called compounding. Just a few select pharmacists make such medications.
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