Complex regional pain syndrome (CRPS): survey of current practices

There are numerous treatments for complex regional pain syndrome (CRPS). These treatments are varied in scope and include pain management therapies, psychological therapies, and physiotherapy. Treatment guidelines have been published in the past, but little information exists as to how clinicians utilize these guidelines. Moreover, there has been a paradigm shift from the older "reflex sympathetic dystrophy" (RSD) nomenclature, with largely sympathetic block driven diagnosis and therapy to more recent trends towards more inclusive "CRPS" diagnostic criteria and multidisciplinary treatment. There remains controversy regarding the selection of various techniques, and the timing of advancement through the treatment algorithm to the more aggressive, interventional techniques. We set out to determine current CRPS treatment practices of interventional pain specialists.

The authors developed a 36-item, 15-20-minute questionnaire. This questionnaire was sent to 453 interventional pain specialists.

One-hundred-five surveys were returned, with 100 being complete. Eighty-three percent of our respondents were practicing anesthesiology pain specialists who on average treat 14.9 (SD = 16.8) CRPS patients per month.

Our survey results revealed the use of a treatment algorithm for CRPS that consists of treatment using medical therapies (pharmacologic, blocks, catheters, and implantable devices), psychological therapies, and physiotherapy in a coordinated fashion. The trend among our survey respondents is to utilize increasingly interventional techniques after a failed 2- to 4-week trial of any one particular therapy.