Aim Patients with Complex Regional Pain syndromes require multidisciplinary care to be managed effectively. Relief from the symptoms of neuropathic pain often requires the use of centrally acting medications, as well as physiotherapy and psychological support. There is currently no evidence of the relative clinical efficacy or side effect profiles of the medications used for neuropathic pain management.
Methods A retrospective audit of paediatric patients with a diagnosis of complex regional pain syndrome attending a tertiary referral clinic (November 2008 – March 2013) was carried out to determine the pattern of medication use for neuropathic pain relief.
Results Thirty-two patients were identified, average age at diagnosis 11y 9 m, male gender 25.0% (n = 8). No patient had a validated pain score/tool used at diagnosis. A prescription for a neuropathic pain medication was present in 93.8% (n=30). Physiotherapy was undertaken in 93.8% (n = 30) and psychology input was present in 56.3% (n = 18). The first medication used was Amitriptyline 86.7% (n = 26), combination Amitriptyline and Gabapentin 6.7% (n = 2), Gabapentin 3.3% (n = 1) and Pregabalin 3.3% (n = 1). Over the course of their treatment, the median number of neuropathic pain medications used was 2 (range 1–4), with 46.7% (n = 14) children only requiring a single medication, 33.3% (n = 10) requiring two, and 20% (n = 6) requiring 3+. The number of children receiving each medication is shown in Table 1. At the end of the audit process, 56.7% (n = 17) were still using these medications.
Conclusion Amitriptyline is the most commonly used drug for initiating pain therapy in chronic pain, but during treatment there are a number of other medications used. Pharmacologically, the medications used have different modes of action, and hence there is reason to believe that there may be different rates of efficacy in these conditions, and different side effect profiles. Prospective studies are needed in this area to determine the optimal place of each medication in the treatment of neuropathic pain in complex regional pain disorders.
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