An Updated Interdisciplinary Clinical Pathway for CRPS: Report of an Expert Panel
The goal of treatment in patients with complex regional pain syndrome (CRPS) is to improve function, relieve pain, and achieve remission. Current guidelines recommend interdisciplinary management, emphasizing 3 core treatment elements: pain management, rehabilitation, and psychological therapy. Although the best therapeutic regimen or the ideal progression through these modalities has not yet been established, increasing evidence suggests that some cases are refractory to conservative measures and require flexible application of the various treatments as well as earlier consideration of interventions such as spinal cord stimulation (SCS). While existing treatment guidelines have attempted to address the comprehensive management of CRPS, all fail to provide guidance for contingent management in response to a sudden change in the patient's medical status. This paper reviews the current pathophysiology as it is known, reviews the purported treatments, and provides a modified clinical pathway (guideline) that attempts to expand the scope of previous guidelines.
Keywords: RSD; causalgia; clinical pathway; complex regional pain syndromes; guidelines; neurostimulation; pain management; pharmacology; psychological therapy; regional anesthesia; rehabilitation; treatments
Document Type: Research Article
Affiliations: 1: The Cleveland Clinic Foundation, Cleveland, OH; 2: The University of Texas M. D. Anderson Cancer Center, Houston, TX; 3: Vanderbilt University Medical Center, Nashville, TN; 4: New England Medical Center, Boston, MA; 5: The Rehabilitation Institute of Chicago,Chicago, IL; 6: Rush Pain Center, Chicago, IL; 7: Yellowstone Neurosurgery Associates,Billings, MT; 8: Texas Tech University Health Sciences Center, Lubbock, TX; 9: Piedmont Anesthesia and Pain Consultants, P.A., Winston-Salem, NC.
Publication date: March 1, 2002