When I first meet a new patient who comes with CRPS, I ask about current medication use. The answers to this question vary from over the counter preparations to prescribed drugs for inflammation and neuropathic pain. For example, paracetamol, anti-inflammatories or NSAIDs (neurofen, naproxen, voltarol), opioids (tramadol, oxycodone, codeine), anti-depressants (amitriptyline, nortriptyline) and anti-convulsants (pregabalin, gabapentin). Medication has an important role to play but must be used wisely, appropriately and optimised for the pain type(s), similar to a lock and key. If the key fits the lock the door will open, in other words when the drug attaches itself to the target receptor there will be action but if it does not match there will not be an effect.
There can be different pain mechanisms at the root of the CRPS symptoms. Commonly we see neuropathic pain and inflammatory pain, the latter often due to neurogenic inflammatory mechanisms when the nerves themselves release chemicals–substance P and CGRP–into the tissues that they supply, triggering inflammation. In this case, your doctor could prescribe medication for neuropathic pain such as gabapentin alongside an anti-inflammatory drug.
I believe in a model of care that is inclusive of appropriate physiotherapy, pain medicine and psychology, working together to provide a psychosocial programme of care. Not everyone will require input from all three disciplines, but this model as a start point means that all aspects of the condition and the effects are considered. Further, these disciplines must be providing care that is based upon the latest thinking and science of both pain and CRPS. As a physiotherapist specialising in chronic pain and conditions such as CRPS, I have ensured that those I work with are dedicated to the contemporary provision of treatment. Therefore, returning to the issue of appropriate and effective medication use, when I ask about the drugs and their effect, it is so I can see whether a review is required to optimise the overall programme of treatment. In the case that I feel the medication is not being optimised, I will recommend that you see one of the pain specialists whom I know will be able to advise you on the most appropriate drug for your current state and how best to use it within the programme.
Briefly, I think it is important to point out that I do not prescribe or change patient’s medication. This is the job of your doctor or consultant. If you do not have a nominated doctor or specialist who is looking after your medication use, I will gladly recommend one who can help you.