Pharmacological Therapies

Various analgesics have been proposed, but no specific treatment has been consistently effective in children with CRPS.64 The appropriate role for medication is to alleviate pain, improve sleep, and facilitate physical therapy.

• Tricyclic antidepressants are offered primarily to ameliorate para-insomnia and reactive depression that are often associated with persistent pain.65'66

• Anticonvulsants have a promising benefit, but the data on their use in CRPS are experience-based and anecdotal.67 [V], 68[V], 69[II]

• Nonsteroidal anti-inflammatory drugs (NSAIDs) may alleviate pain from inflammation and even partial pain relief is desirable to mobilize the painful limb.

• Opioid use is controversial and efficacy is yet to be demonstrated. Opioids are prescribed for short-term treatment of acute pain or on time-contingent schedule prior to physical therapy in order to maximize compliance with mobilization of the painful limb.

• Other therapies including antagonist of calcium channel, sodium channel, beta-adrenergic, and alpha-adrenergic receptors, calcitonin, steroids, and Lidoderm (5 percent) patches have shown to produce short-term relief of pain in uncontrolled trials.68[V], 70[IV], 71[IV], 72[V], 73[III], 74[III], 75[V]

• Baclofen and clonazepam have been prescribed for symptomatic treatment of dystonia and muscle spasms with variable success.76

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