Dr Ramos-Galvez and Dr Jenner discuss treatment options for Complex Regional Pain Syndrome

4 Apr 2018

Dr Ivan Ramos-Galvez and Dr Christopher Jenner are skilled consultants in pain medicine with extensive experience in treating and managing Complex Regional Pain Syndrome (CRPS).

Both experts have explored a range of treatment methods to manage and treat the symptoms of chronic pain and discuss the most effective treatments they use.

Treatment usually consists of 4 areas:

Education and Self-Management this involves advice about the steps the sufferer can take to help manage the condition.

Physical Rehabilitation and Therapy – to help improve function and reduce the risk of long-term physical problems.

Pain Relief – treatments to help reduce pain.

Psychological Support – interventions to help cope with the emotional impact of living with CRPS.


Analgesic Options

The most common method of treatment begins with oral medications which can be prescribed by the patient’s GP. These include:

Non-steroidal Anti-inflammatory Drugs (NSAIDs) – this medication can be obtained over-the-counter in the form of commonly known pain relief such as ibuprofen. Stronger NSAIDs such as diclofenac and naproxen must be prescribed by a clinician. NSAIDs can be very effective for acute muscular and bone pain as well as CRPS, they work by blocking the COX enzymes and reducing prostaglandins throughout the body. As a consequence, ongoing inflammation, pain, and fever are reduced. Since prostaglandins, protect the stomach and support platelets and blood clotting, taken long term they can create nasty side effects including stomach ulcers and gastrointestinal bleeding and so are not suitable for all patients.

Tricyclic Antidepressants – can also be very helpful in controlling pain; specifically, tricyclic antidepressants. The pain-relieving properties of these medications are such that they can relieve pain in doses that are lower than that needed to treat depression. These medications are not meant to be taken on an “as needed” basis but must be taken every day whether or not the sufferer is experiencing pain. Side effects can include drowsiness and a dry mouth.

Anticonvulsants – can treat the tell-tale symptoms of CRPS such as burning and shooting pain sensations in the affected area/s. Common side effects include drowsiness, which can improve over time as the body adjusts to the medication, and possible weight gain.

Opioid Therapy – when used appropriately, opioids can be very effective in controlling pain. One of the most frequent side effects is constipation which can be treated with other medications. Drowsiness is another common side effect which similar to antidepressants, can improve over time.


Conservative Treatment

Other conservative treatment options for CRPS include physiotherapy, acupuncture, clinical pain psychology and Transcutaneous Electrical Nerve Stimulation (TENS).


Pain Management Procedures

If conservative treatment does not reduce the pain, a patient may be considered for a pain management procedure. These include:

Minimally Invasive Pain Management Procedures – Most of these procedures are performed under x-ray guidance and can usually be done either with the patient awake under local anaesthesia or the addition of a small amount of sedation. They generally involve the injection of mixtures of local anaesthetic and long-acting steroid preparations.

Advanced Pain Management Procedures Spinal cord stimulation involves having a device placed under the skin attached to a lead placed close to the nerves in the spine. Mild electrical pulses are sent to the spinal cord. These pulses change how the patient feels pain and may feel a tingling sensation in the affected limb, which masks the pain. The level of stimulation can be adjusted as the pain improves or gets worse.


The complex and unpredictable nature of CRPS requires a multi-modal approach, usually involving a team of specialists to work either individually or jointly in the form of a pain management programme to reduce the intensity of the pain and the impact it can have on the patient’s life.

For this reason, it’s necessary to instruct an expert in pain medicine who is regularly diagnosing and treating CRPS and who will be best placed to assess a claimant and provide a comprehensive prognosis and opinion.


Dr Jenner and Dr Ramos-Galvez offer consultations within 7 days and a full report within 4 weeks. Both are skilled consultants in pain medicine who specialise in the treatment of CRPS. If you would like to instruct them, please contact 0207 118 0650, info@medicolegal-associates.com or go to our contact page.