Zbornik radova 2012 - Udruženje Fizijatara Srbije

enduring disabilities resulting from CRPS are hand contractures. Gentle
active or active assisted range of motion should begin in a pain-free fashion.
Any advancement in therapy should proceed slowly and carefully, keeping in
mind that an overly aggressive approach may increase pain and swelling,
which would be counterproductive.
A combination of medications may be used including NSAIDs,
tramadol, sodium channel blockers (intravenous lidocaine), N-methyl-Daspartate
[NMDA] receptor blockers (ketamine, dextromethorphan),
calcium-regulating drugs (calcitonin, alendronate), free-radical scavengers
(transdermal dimethylsulfoxide [DMSO], gaba-pentin, antidepressants
(amitriptyline), and various a1-blockers and steroids. Injected pain relieving
medications, spinal cord stimulation, and implanted medication delivery
pumps may provide pain relief for longer periods of time (12). However,
physical modalities should be the first line of defense. Transcutaneous
electrical nerve stimula-tion (TENS), and other anti-inflammatory and
analgesic physical modalities, as well as, and desensitization may be used
before and after therapy session or exercise. If these are unsuccessful in
adequately controlling the pain to the point at which therapy can be
progressed, then one may consider further pain-relieving measures.
Additionally, aquatic therapy can provide a warm and supportive
environment for you to safely exercise. In many cases treated with steroid
injections, physical and exercise therapy should immediately follow an
injection, to take advantage of the relief the injection may provide. Surgery
is rarely indicated for CRPS. For those cases in which the syndrome is
caused by nerve injury or compression, surgery to resolve the problem can
help relieve symptoms (13,14).
The principle treatment for RSD/CRPS is physical therapy. Early
diagnose to achieve prompt pain control and maximize the use of the
extremity will most patients improve. If CRPS is not diagnosed and treated
promptly, irreversible changes can occur in the involved extremity.
References:
1. Li Z, Smith BP, Tuohy C, Smith TL, Andrew Koman L. Complex regional pain
syndrome after hand surgery. Hand Clin 2010;26:281-9.
2. Albazaz R, Wong Y, Homer-Vanniasinkam S. Complex regional pain
syndrome: a review. Ann Vasc Surg 2008;22:297-306.
3. Zyluk A. Complex regional pain syndrome type I. Risk factors, prevention and
risk of recurrence. J Hand Surg Br 2004;29:334-7.
4. Harden RN, Bruehl S, Stanton-Hicks M, Wilson PR. Proposed new diagnostic
criteria for complex regional pain syndrome. Pain Med 2007;8:326-31.
5. Verdugo RJ, Ochoa JL. Sympathetically maintained pain: I. Plentolamine
block questions the concept. Neurology. 1994;44:1003–1010.
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