Pharmacotherapy of complex regional pain syndrome

Complex regional pain syndrome has both nociceptive/inflammatory and neuropathic elements and is always (by definition) associated with abnormal activity of the sympathetic nervous system. There is good evidence that complex regional pain syndrome, as currently conceptualized, ultimately includes central sensitization and has motor abnormalities. The lack of a standard diagnostic test or a specific mechanistically based diagnostic scheme has hindered the conduct of well-designed trials, and to date, there is very little evidence supporting an effective treatment. Fortunately, some randomized, controlled trials of drug therapies have been conducted, and systematic reviews have been published of related neuropathic conditions, from which the results have been extrapolated to clinical use in complex regional pain syndrome. The following article presents an overview of available data regarding drug and interventional treatment options for complex regional pain syndrome and of those relevant pharmacotherapies we can derive from the neuropathy literature. As with most chronic pain syndromes, pharmacotherapy coupled with functional restoration and an interdisciplinary approach to treatment are essential to a successful outcome.