Which medications in the drug class Analgesics are used in the treatment of Complex Regional Pain Syndrome in Emergency Medicine?

Updated: Nov 08, 2018
  • Author: Steven J Parrillo, DO, FACOEP, FACEP; Chief Editor: Andrew K Chang, MD, MS  more...
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Pain relief should be a high priority. Pain control is essential to quality patient care. Analgesics ensure patient comfort, promote pulmonary toilet, and have sedating properties. Note that controversy exists among authors about the appropriateness of chronic narcotic analgesia. Some are opposed. Others note that, when more specific measures fail, patients must have pain relief in order to live their lives. The latter believe that patients with CRPS have a true chronic pain syndrome.

Morphine sulphate (Duramorph, MS Contin)

DOC for analgesia because of reliable and predictable effects, safety profile, and ease of reversibility with naloxone.

Initial dose dependent on whether patient already is taking narcotic analgesics. For patients not using long-term agents, as little as 2 mg IV/SC may be sufficient, though higher doses are often needed. Larger doses may be required in patients taking long-term narcotic analgesics.

Also available in oral form in immediate-release and timed-release preparations. Long-acting form usually is administered q12h, but many believe that it loses much of its effect after 8 h; immediate-release form may be needed for periods of pain "break-through," dose dependent on previous use. ED physician should begin at lowest available dose in newly diagnosed patients.

No intrinsic limit to the amount that can be given exists, as long as patient is observed for signs of adverse effects, especially respiratory depression. Various IV doses are used, commonly titrated until desired effect obtained.

Hydromorphone (Dilaudid)

Used to manage moderate to severe pain. Available IV and PO.

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