Medications

Because information about medications used to treat CRPS is constantly changing, the following lists of medications are by no means comprehensive. For more detailed information about medications used for CRPS, refer to the consumer edition of the Physicians’ Desk Reference. Never use this information to treat yourself. It is no substitute for the experience and knowledge of your health care provider.

Medications are given to help decrease or stop pain and discomfort caused by CRPS. You may be given more than one medicine to control your CRPS. For example, you may need a pain medicine to take every day and another to take before therapy or during pain flare-ups. Your health care provider will recommend medications based on:
 

• What CRPS signs and symptoms you have and how severe they are
• If you are having other CRPS-related problems such as panic, anxiety, depression and/or sleep problems
• Whether or not you have a nerve injury with your CRPS (CRPS-II)
• How experienced and up-to-date your provider is about CRPS

Some medications can be bought over-the-counter (OTC) at your local pharmacy or grocery store, while others require a prescription. A number of medications for treating CRPS are used in an off-label manner. You may take one or more of the following medications to control your pain and discomfort:
 

• Anti-convulsants – Anti-convulsants are drugs that were originally used to treat seizures (convulsions or epilepsy). Now, certain anti-convulsants are used to help decrease pain in some people with CRPS. Health care providers often give a medicine called gabapentin (Neurontin) because it is relatively safe and has few side effects. The most common side effects of gabapentin are dizziness and sleepiness. Newer anti-convulsant drugs such as pregabalin (Lyrica) also are showing promise for the treatment of pain.

• Anti-depressants – These medicines were originally used to treat depression and other related disorders. Now many of them are also used to treat nerve pain. This class of medicine may help in three ways: relieve pain, improve sleep and decrease depression in people who have it.

• Anti-hypertensives and alpha-adrenergic antagonists – These drugs are commonly used to treat people with high blood pressure (hypertension). However, they may also be used to treat your CRPS by improving blood flow to your CRPS-involved limb. They may also help to decrease pain by exerting some chemical effect on nerve cells in the spinal cord and brain. One example of this type of drug is Clonidine (Catapres). It can be taken by mouth or applied as a skin patch or in a skin ointment. It has also been used in implantable pumps that put medicine directly into your spine.

• Anxiolytics/hypnotics (Benzodiazepines) – Your health care provider may give you this medicine to treat anxiety and/or sleep problems. If these medicines help relieve those problems, they may also have an added effect of decreasing your pain.

• Biphosphonates and calcitonin – People with CRPS commonly have bone loss in their CRPS-involved limb. Bone loss causes the bones to become soft, brittle and easier to break. Causes of bone loss may include not moving your limb enough and decreased blood flow to the CRPS-involved area. Biphosphonates and calcitonin help to decrease bone loss and control calcium levels in your blood. A number of research studies have been done to test biphosphonates as a treatment for CRPS. Experts have found that biphosphonates can greatly decrease pain in some People with CRPS, while calcitonin may offer mild pain relief.

• Corticosteroids – These drugs may be helpful in reducing pain and inflammation (redness, swelling). They may be given as a short-term treatment in the early stages of CRPS.

• Muscle relaxants – These drugs are used to treat muscle spasms. Some of these medicines help relieve anxiety and sleep problems and may have an added effect of decreasing your pain.

• NMDA receptor antagonists – This class of drugs has been used for a long time in the treatment of CRPS and other long-term pain disorders. These medicines act chemically on nerve cells to decrease pain. Unfortunately, their use is very limited because of serious side effects such as severe emotional disturbances. Some examples of these drugs are dextromethorphan (a common element in cough medicines) and ketamine (ketalar). There is recent interest in the use of “ketamine coma” to treat CRPS. This is a dangerous procedure that has been used mostly in Europe and is not approved in the U.S. by the FDA. We are awaiting further outcome studies.

• Nonsteroidal anti-Inflammatory drugs (NSAIDs) – These medicines may help relieve pain, redness and swelling (and also fever). Many of these drugs have familiar names that you may have read about in magazines or seen on TV. See a list of commonly used NSAIDs for CRPS.

• Opioids – These medicines are often used as the first pain reliever of choice, especially if your pain is preventing you from having physical and occupational therapy. These drugs must be used with caution, as they have more serious side effects than other classes or medicine. There are also possible problems with addiction related to their use. Some side effects of opioids include upset stomach (nausea), constipation and bloating. See a list of commonly used opioids for CRPS.

• Other analgesics (pain relievers) – These analgesics may be given to relieve your pain. They include acetaminophen (Tylenol, Panadol, Tempra) and Tramadol (Ultram).

• Skin patches, creams and ointments – Skin patches, creams or ointments contain medicine that may relieve pain on the area where it is applied or rubbed on.