[Drug therapy of complex regional painful syndrome of the limbs as the cause of neuropathic pain]

Abstract

The term complex regional painful syndrome of the limbs seeks to clarify previous entities known as sympathicoreflex dystrophia and causalgia. Its diagnosis continues to be difficult despite the International Association for the Study of the Pain efforts for distinguish both entities. The predominant symptom is characteristically the neuropathic pain whose response to the current analgesic drugs is generally poor. Glucocorticoids are among the most frequent used drugs in the treatment of this syndrome; their effectiveness is, however, not entirely demonstrated and they give rise to important side effects that impede their use in patients with other concomitant conditions. Opioids are difficult to manage because of their side effects which require a strict control by the physician. The use of tricyclic antidepressants because of its analgesic effect is also associated to severe side effects that can be potentially lethal in patients with cardiopathy. In the heterogeneous group of anticonvulsant drugs gabapentin is regarded the treatment of choice because it seems to provide a high improvement of the quality of life in these patients besides a good safety profile.