What other modalities can be used to treat CRPS?
Intravenous regional bretylium Bier blocks can
be per-formed along with or in lieu of sympathetic nerve blocks. Bretylium is a
sympatholytic agent that decreases cate- cholamine release from nerve endings.
Mixed somatic/ sympathetic blocks such as epidurals or spinals can be used but
will lack diagnostic specificity. Oral sympatholytics such as β-blockers will
decrease sympathetic discharge but can cause systemic side-effects especially
related to the car- diovascular system. Anticonvulsant agents, tricyclic anti
depressants, oral steroids, and antiarrhythmic agents have also been described
as therapies for CRPS. Spinal cord stimulation has recently shown very
encouraging results for the treatment of refractory CRPS. Physical therapy to
prevent the trophic changes associ- ated with CRPS is of the utmost importance
in conjunc- tion with other treatment modalities. The key to successful therapy
seems pre-eminently dependent on treating the syndrome as early as possible.
Psychotherapy is sometimes a productive adjunct.