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Centre for Orthopaedics
Suite 10-33/34/35 Mount Elizabeth Novena Specialist Centre
38 Irrawaddy Road
Singapore, 329563, Singapore
Ph: (65) 6684 5828
Fax: (65) 6684 5829

Child Orthopedics
Pain Management
Spine - Cervical
Spine - General
Spine - Lumbar
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I have a painful condition called complex regional pain syndrome. I live in the U.S. but I'm wondering how this condition is treated in other countries. Are there any breakthroughs we don't know about?

Complex regional pain syndrome or CRPS is a very painful disorder that affects people after a seemingly minor injury sometimes. People with complex regional pain syndrome (CRPS) often experience intense pain, swelling and skin changes (color, texture, hair growth, temperature). The net result is a loss of motion and function along with reduced quality of life. The problem is not understood very well. Doctors don't know what causes it or why it happens. That makes CRPS a difficult condition to treat effectively. Scientists in The Netherlands have added a new piece to the mystery of treating complex regional pain syndrome (CRPS). In recent years, anti-inflammatory medications have been used with mixed results -- some studies show it works, others don't. But the fact that this approach works for some patients makes it worth investigating further. If CRPS is an exaggerated response of the immune system to tissue injury, then inflammatory messengers and inflammatory cells must be part of the signaling system that brings on the painful symptoms. The two types of medications being investigated in the Netherlands are corticosteroids and free radical scavengers. Corticosteroids included oral prednisolone and piroxicam (CNT). Free radical scavengers included DMSO, vitamin C, and Mannitol. Free radicals are unstable oxygen atoms that form when they lose an electron. Electrons like to be in pairs. The loss of one electron literally puts the atom into orbit. It becomes a scavenger looking for another oxygen atom so that it can rob or steal the necessary electron. The result is a cascade of damage to the cells as new radicals are formed in order to salvage the damaged oxygen atoms. Compounds like DMSO, vitamin C, and Mannitol work by getting rid of free radicals. Inflammatory reactions are reduced by eliminating free radicals. The end-result is to limit the amount of tissue damage that occurs from inflammation. In some studies, corticosteroids and free radical scavengers were used together. After reviewing all the studies on the use of these medications for CRPS, here's a quick summary of what they found. Both classes of drugs (corticosteroids and free radical scavengers) worked. Patients receiving either medication showed significant improvements. This tells us that it is possible to stop the inflammatory process in different ways (turning off inflammatory cells, getting rid of damaging free radicals). But once again, there were just as many patients who didn't get better as those who did improve. Naturally, the scientists wondered "Why"? (Or more appropriately, "Why not"?). There are no clear answers just yet. Researchers around the world will continue exploring the "whys" and "whats" of complex regional pain syndrome.


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