In a subset of patients with complex regional pain syndrome, dystonia of the affected extremity emerges as a prominent and refractory complication — one that may persist despite initial systemic treatment and structured rehabilitation. This page addresses patients who have reached that failure condition and require the next treatment step.
Dystonia is a common movement disorder in CRPS and often requires independent treatment. It is itself painful and can further worsen pain by impeding tissue perfusion of the affected extremity — creating a compounding clinical burden that systemic oral therapy may not adequately resolve.
First-line management consisted of oral baclofen combined with an interdisciplinary functional restoration program. This approach did not achieve the required targets: decreased dystonia of the affected extremity, improved tissue perfusion, and decreased pain intensity.
The protocol described here is the defined next step for patients who have reached this failure condition.
When systemic oral therapy does not provide adequate dystonia control, an approach involving targeted drug delivery via an implanted system is among the interventions that may be considered — though the evidence base is limited and complications are a recognised concern.
The clinical goals for this protocol are decreased dystonia of the affected extremity, analgesia, and functional restoration. The complete regimen and selection criteria are available in the full protocol.
DOI: 10.1093/pm/pnac046
Dystonia, a common movement disorder in CRPS, often requires independent treatment.
Dystonia is itself painful and can also worsen pain by impeding tissue perfusion.
If baclofen is effective but poorly tolerated, administration by intrathecal pump is sometimes considered, although pharmacological and mechanical complications are common and the research group that had originally evaluated this intervention has all but abandoned it now (personal communication).
In a small subset of patients (n = 7) with refractory CRPS and severe dystonia, van Hilten et al. demonstrated analgesia and functional restoration after a bolus of intrathecal baclofen injected in a double-blind fashion followed by intrathecal infusion.
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