Oral methadone for management of regional sympathetic dystrophy syndrome: a case revisited

Regional sympathetic dystrophy syndrome (reflex sympathetic dystrophy, complex regional pain syndrome) is a multifactorial disorder characterized by chronic pain, edema, sweating, sensory changes, and temperature disturbance in affected extremities. In the September/October 2005 issue of the International Journal of Pharmaceutical Compounding, the successful treatment of artist Karen Balzer, who suffers from total body regional sympathetic dystrophy syndrome, was described. At that time, a compounded solution of morphine administered by an implanted intrathecal infusion pump provided her only relief from constant overall burning paresthesia and severe chronic pain in her legs and feet. In this article, that case is revisited, and Balzer's current treatment with oral methadone (which is simpler and less expensive than her prior therapy but equally as effective) is described with comment from her pain management specialist, Jack P. McNulty, MD. Formulations for compounded oral, subcutaneous, and transdermal forms of methadone are provided by George Muller, RPh.