46 yo F pmh right carpal tunnel release 6 months ago presents with intermittent swelling, pain as in burning, feelings of warmth and cold, and hypersensitivity to right hand worsening over past 6 month. What is the diagnosis ? treatment?
A:
Complex Regional Pain Syndrome
Medications
- Pain relievers. Over-the-counter (OTC) pain relievers, such as aspirin, ibuprofen (Advil, Motrin, others) and naproxen (Aleve), may ease pain and inflammation. Your doctor may prescribe stronger pain relievers if OTC ones aren’t helpful. Opioid medications may be an option.
- Antidepressants and anticonvulsants. Sometimes antidepressants, such as amitriptyline, and anticonvulsants, such as gabapentin (Neurontin), are used to treat pain that originates from a damaged nerve (neuropathic pain).
- Corticosteroids. Steroid medications, such as prednisone, may reduce inflammation and improve mobility in the affected limb.
- Bone-loss medications. Your doctor may suggest medications to prevent or stall bone loss, such as alendronate (Fosamax) and calcitonin (Miacalcin).
- Sympathetic nerve-blocking medication. Injection of an anesthetic to block pain fibers in your affected nerves may relieve pain in some people.
Therapies
- Applying heat and cold. Applying cold may relieve swelling and sweating. If the affected area is cool, applying heat may offer relief.
- Topical analgesics. Various creams are available that may reduce hypersensitivity, such as lidocaine or a combination of ketamine, clonidine and amitriptyline.
- Physical therapy. Gentle, guided exercising of the affected limbs may help decrease pain and improve range of motion and strength. The earlier the disease is diagnosed, the more effective exercises may be.
- Transcutaneous electrical nerve stimulation (TENS). Chronic pain is sometimes eased by applying electrical impulses to nerve endings.
- Biofeedback. In some cases, learning biofeedback techniques may help. In biofeedback, you learn to become more aware of your body so that you can relax your body and relieve pain.
- Spinal cord stimulation. Your doctor inserts tiny electrodes along your spinal cord. A small electrical current delivered to the spinal cord results in pain relief.
Recurrences of complex regional pain syndrome do occur, sometimes due to a trigger such as exposure to cold or an intense emotional stressor. Recurrences may be treated with small doses of antidepressant or other medication.
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