FWD:RSD World News-Complex Regional Pain Syndromes- New Directions in Treatments

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From: byrd45 (Original Message) Sent: 8/6/2006 8:56 PM
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Taken from


22nd Annual Meeting of the American Academy of Pain Medicine


Complex Regional Pain Syndromes -- New Directions in Treatment
The complex regional pain syndromes are characterized by vasculopathic and neuropathic processes with varied phenotypic presentations; physiologic research points to common central pathways. The first physiologic event is most probably stimulation of an inflammatory cascade that alters central processing and leads to a central nervous system disorder with thalamic reorganization and cord processing reorganization. The paradigm of care has shifted in light of data showing significant benefits of spinal cord stimulation and nerve root stimulation in complex regional pain syndromes (CRPS).[35] Results from one recent study showed abolishment of allodynia and 80% reduction in deep pain, with 75% of patients returning to work and more than 56% stopping pain medications. Newer recommendations for interdisciplinary treatment (medications/injections/psychological/physical therapy) after diagnosis indicate multimodal treatment for the first 3 months; if quiescence of the syndrome does not occur, then progression to spinal cord/nerve root stimulation should then proceed.[36,37] Ablative therapies (ie, sympathectomy) show poor long-term outcome and are only recommended when "all else" fails.

Ronald Harbut, PhD,[38] discussed novel medications for CRPS in a session about new directions for treatment. He presented new data on the use of ketamine in the medical treatment of the pain of CRPS. Retrospective data showed that 76% of patients responded (experienced complete pain relief) to subanesthetic doses of ketamine. Following the first course of therapy, 54% of patients remained pain-free for longer than 3 months. Hallucinations occurred in 18% of patients and hepatic enzyme profile changes occurred in 12% but normalized at cessation of therapy; less frequent side effects were dizziness, light-headedness, and nausea. Dr. Harbut did note that in his experience, side effects tended to fade with time.