Differences in the Treatment of CRPS in the world
A small view around the available options for a patient suffering from CRPS.
It is well known that Complex Regional Pain Syndrome is a condition that can be very challenging to diagnose and treat. This is due to many factors: from the many known causes of development of the syndrome, all the way to the very personal nature of it, by involving symptoms like pain.
The diagnose itself is made by excluding any other condition that may present similar symptoms. There is no test that can confirm the diagnosis, rather than guidelines to follow (for example the McGill scale of pain or the Budapest Criteria). The treatment itself might result a bit confusing and put the patient in discomfort due to the lack of answers he or she might find.
The patient might think to be in a situation from which it is difficult to come out (which is true), but it is vital to realize that it is not difficult. The reality is that, first, a patient must be extremely sure of the diagnosis and this problem can be solved by going for a second and even third opinion. Once the patient is sure of the diagnosis, the best way to treat the condition is through a multidisciplinary approach.
This does not mean that there is no treatment or therapy available for CRPS, it simply means that the only way to treat it, today, is to “attack” every single symptom of this condition. The patient is in a very uncomfortable situation: it will seem as if there was a “market” of available therapies that will work in this or in that way. Where there is a market, there most likely are interests and the patient will have to choose the best suiting therapy path. This is terrible because the patient will have to do something that he or she has no qualification for, and it will most likely result into a delayed correct therapy.
There are many factors that could influence the patient’s decision: from the trust in the doctor, financial reasons, all the way to (and this is the most dangerous one) the urge of making the pain go away. Here, we try to condensate the therapies available all over the globe to treat CRPS.
A first, substantial, difference can be found in the general philosophy and approach of the local healthcare. A mostly privatized healthcare will be forced to look at the financial side of the options: such a healthcare will base itself on agreements with pharmaceutical companies as well as the immediate good outcome for the patient. Therefore, it is dangerous to focus on the pain: it will probably result into a therapy path that will alleviate the pain but will not cover all the symptoms rather than the dominating ones. On the other hand, in a public healthcare, the patient is “an expense” of resources, especially one suffering from a chronic condition. The goal here would be to search for a path that will take care of everything, to ensure the patient’s wellbeing on the longest possible term. To reach this goal the path can be harder and require a bigger effort on the patient’s side.
This is important because we must keep in mind that in every country a doctor can only offer what the local healthcare has available. Therefore, when it comes to Complex Regional Pain Syndrome, there are countries that mainly focus on the pain factor and treat that side of the problem. Although every research clearly suggests that the only way to treat this condition is a multidisciplinary approach. This means that there will have to be a coordinated work between different health specialties: a rehabilitation program built around the patient and adjuvated by minor pain management therapies, as well as a psychologist and even a dietitian will have to work all together to aggress this condition.
Many patients often find themselves in front of a diagnose carried out only by one doctor which usually is the only doctor treating that condition. Although, with a good dose of luck, this path could be effective, the outcome will most likely not be satisfactory. In many countries, for example, the typical patient will strongly rely on pharmaceuticals to feel better not counting that, in chronic conditions, these methods are usually less and less effective on the long run. As a matter of fact, by looking at the statistics, the classic patient suffering from CRPS is often undergoing other treatments or going through preexisting health issues, physical as well as psychological. This is where, in the countries where people are more used to “natural” methods like, for example, in Latin America as well as Mediterranean Nations (Spain, Italy, France..) a patient is statistically more aware of the situation and more prepared to undergo very challenging programs before a pharmaceutical one.
For example, in Latin America, as it happens in Spain, the guidelines for the treatment of Complex Regional Pain Syndrome suggest minor pain management drugs (Tylenol or, in the more extreme cases, steroids) sided by a rehabilitation therapy with a strong emphasis on Mirror Therapy. These countries are starting to consider the use of Ketamine as a major pain management treatment, this option is however under investigation as there are no studies supporting it in a resolutive way and it has terrible side effects. It is important to underline that in these countries (as well as in Italy, France etc..) Ketamine is usually used into a cocktail to put patients into a pharmaceutical coma and is only now being considered for pain management. In Italy, for example, it still is illegal to use this drug for these reasons as it often causes more harm than good, only a selected number of clinics has permission to try this option.
Other countries, like the United States, are more advanced in the offer of pain management treatments that can be extremely helpful with the correct therapy path but, as we know, are not a resolutive option. The only pharmaceutical treatment that shows its effectiveness in many different researches is the one involving bisphsphonates. As a matter of fact, the correct protocol for the treatment of Complex Regional Pain Syndrome requires a first use of minor pain management pharmaceuticals with the cooperation of the doctor and the therapists. As soon as the specific protocol for the patient is designed, bisphosphonate infusions are the second step. The treatment with the use of bisphosphonates has shown great results and in many countries it is the treatment choice.
However, while all the other bisphosphonates show promising results but the methods in terms of dosage and frequency are under discussion, only Neridronate has been labeled specifically for the treatment of CRPS. This bisphosphonate has its own protocol and it is the safest to use as it is also administrated to kids all the way to 2 years old.
Bisphosphonates have shown to be effective in the prevention of worsening of the condition: Neridronate in particular is the only pharmaceutical that has been directly linked to a remission from the condition. Moreover, for patients that have been suffering from this condition for a very long time, it prevents the outburst of Ostheoporosis, a common complication of CRPS.
A multidisciplinary approach is the recommended path for the treatment of this condition is recommended in countries all over the globe but very few offer this kind of cooperation between specialists. Once the pharmaceutical side is done, the patient should go on workig with the rehabilitative program that will require patience, but will in return grant a normal and functional life.