The treatments for causalgia, which is a synonym for complex regional pain syndrome type II (CRPS II), include pain medications, nerve blocks, psychotherapy and physical therapy. Spinal cord stimulation or sympathectomy — surgery that removes connections between nerves that may be over-firing and causing pain — can also be considered. Each patient is different, which means treatments will be individualized and are based on the response of the patient.
Several types of therapy are recommended for causalgia, though these are not primary treatments. The disease has been linked to an elevated risk for suicide, which suggests the importance of psychotherapy, and perhaps antidepressants. There is a reliable correlation between cognitive and emotional perceptions of pain plus psychosocial stress and the physical experience of pain. Psychotherapy and/or participation in cognitive behavioral pain programs may thus help improve causalgia symptoms. Additionally, physical and occupational therapy employ a variety of techniques to help improve function and reduce discomfort.
Since causalgia is considered the more severe type of CRPS, it does not always readily respond to drug treatment. Nevertheless, several different drugs might be suggested to help produce comfort. These include opioids, but medications of this type are addictive and aren’t always recommended. Alternately, drugs that act on nerve pain, like gabapentin, could be tried or some older antidepressants from the tricyclic class might be suggested. Non-steroidal anti-inflammatory drugs (NSAIDs) may also have a role in addressing discomfort created by inflammation.
Drug treatments alone are seldom fully effective, leading physicians to try other approaches. Nerve blocks, which create numbness in the affected area through injection of medications, are often considered an effective, temporary causalgia treatment. In a few patients, a block not only alleviates pain, but also causes symptoms to remit entirely. Other individuals need repeated blocks to keep pain from returning in full.
Another option for causalgia treatment is exterior or interior stimulation of the spinal cord. Electrodes or patches can be placed on the skin near the spine, and patients can control these, creating small tingling sensations in areas where pain occurs. Alternately, surgeons can implant these electrodes. They are still subject to patient control and might reduce serious symptoms for some individuals.
The most aggressive, but still frequently performed treatment for causalgia is a surgery called sympathectomy. It might be recommended, especially if patients have positively responded to nerve blocks, because this suggests significant involvement of the sympathetic nerve pathway. This surgery may be done in an open manner or laparoscopically, and involves severing the connection between some of the nerves so that pain signals are no longer produced. Sympathectomy can have a high success rate if patients have previously responded well to nerve blocks.