Drugs Commonly Used to Treat RSD
Drugs Commonly Taken By RSD Patients (Survey) Disclaimer
Introduction: Drugs Commonly Used to Treat RSD
I. Anticonvulsants
These drugs are commonly used to treat neuropathic pain (pain from nerve damage) and are therefore often used in RSD. Side effects include sedation, constipation, difficulty urinating, impotence, etc. In some cases of RSD however, they are used with significant benefit. With any of these they may have serious side effects so you should discuss this with your doctor and get a package insert from the pharmacist. They include:
- Neurontin (gabapentin).
- The newest and with much fewer side effects than the older drugs. The most common side effect is sedation. Usually, if started slowly and built up over a period of a month or so, this drug is tolerable and can provide good pain relief in many people with RSD.
- Tegretol (carbamazepine).
- Also commonly used for RSD. It has many side effects and is not tolerated by many people but has good pain relieving qualitites if tolerable.
- Klonopin (clonazepam).
- Similar to valium-like drugs (benzodiazepines) but has analgesic properties, and can aid with muscle spasm and anxiety.
- Dilantin.
- Also used but has high side effect frequency.
- Depakote.
- Causes sedation, not commonly used in RSD
II. Antihypertensives
Many drugs which are used to control blood pressure do so by inhibiting the sympathetic nervous system, which of course is linked to RSD, or by dilating blood vessels and therefore are useful in improving blood flow in late RSD. These include:
- Clonidine (Catapres).
- Inhibits the sympathetic nervous system, comes as a patch which is slow release or a tablet. Common side effects include impotence, dry mouth and postural hypotension (weakness from low blood pressure upon standing).
- Verapamil (Calan).
- Calcium channel blocker which dilates blood vessels and may be helpful in RSD. Side effects include fluid retention, dizziness, nausea and headache. Drug interactions include cimetidine, tegretol, lithium and beta - blocking drugs.
- Nifedipine (Procardia).
- Also a calcium channel blocker, similar to verapamil but mostly dilates blood vessels and has few effects on the heart. Recently the short acting form of this drug was associated with an increased incidence of heart attacks. It is, however, usually prescribed as the long-acting form (Procardia XL) which does not appear to be associated with this and is commonly used to treat RSD in stages where blood flow appears compromised.
- Beta-blocking drugs, propranolol (Inderal), atenolol (Tenormin).
- These are generally used for hypertension or heart irregularities but may also be used for RSD and migraine headaches. Side effects include low blood pressure and heart rate which can lead to dizziness or fainting, impotence, fatigue and lethargy.
III. Antidepressants
There are basically two types used in RSD, the tricyclic antidepressants (TCAs) such as amitriptylline and imipramine and the newer, selective Serotonin re-uptake inhibitors (SSRIs) such as prozac, zoloft, paxil and serzone.
The only one which has ever been shown to give an analgesic effect is amitriptyline but since depression and sleep disorders are so common with RSD, both types are freqently used and usually may be used together if needed. The TCAs have much more frequent side effects than SSRIs but are also more helpful in restoration of the sleep cycle and the SSRIs have not been shown to have analgesic effects.
- TCAs:
- Elavil (amitriptyline) most commonly used. Causes sedation so is usually given at night. May help restore sleep cycle. Side effects include dry mouth, impotence, blurred vision, urinary retention and should not be used in presence of irregularities of the rhythm of the heart.
Note: Should be stopped if guanethidine Bier blocks are planned for therapy of RSD. If on high doses may have withdrawal syndrome if stopped suddenly.
- May have drug interactions with the SSRIs since they are both metabolized by the same system in the liver, thus increasing the blood level of each.
- Others:
-
- imipramine
- clomipramine
- nortriptyline
- protriptyline
- doxepin
- desipramine
- SSRIs:
-
- fluoxetine (Prozac)
- paroxetine (Paxil)
- sertraline (Zoloft)
- venlafaxine (Effexor)
- nefazodone (Serzone)
- Atypical Antidepressants:
- do not fit in the above chemical groups
- Bupropion (Wellbutrin)
- Trazodone (Desyrel)
IV. Muscle Relaxants
These are commonly used because mayfascial pain and trigger points are very common in RSD, usually in the shoulder or low back. The most common side effect of all of these is sedation but they each have other side effects as well. Unfortunately, like the narcotics, tolerance usually develops and the type of drug may have to be changed occasionally to maintain their effect. Taking them routinely on a long-term basis is not usually recommended except in the case of baclofen.
- cyclobenzaprine (Flexoril)
- carisoprodol (Soma)
- chlorzoxazone (Parafon)
- baclofen (Lioresol)
The benzodiazepines may also be used as muscle relaxants and are listed under anxiolytics.
V. Anxiolytics
These are drugs which decrease anxiety and may also be used to treat seizures (Valium), depression (Xanax), nausea (Ativan)or as muscle relaxants. The major side effects are sedation, memory loss, depression and other mental effects. They may also be very addicting. Tolerance can develop and sudden stopping of use will trigger a withdrawal syndrome.
Examples:
- diazepam (Valium)
- alprazolam (Xanax)
- buspirone (Buspar)
- clonazepam (Klonopin)
- estazolam (Prosom)
- lorazepam (Ativan)
VI. Analgesics
These are drugs that relieve pain. The list could be endless so only the major ones will be listed.
- a) Narcotics:
- "Opiod-like" drugs, either derived from the opium plant such as heroin, morphine, demerol and codeine or synthetic, such as fentanyl (Duragesic), hydrocodone (Vicodin) or methadone. Ususally not used in RSD because it is thought by many physicians that it is inappropriate to prescribe them long-term in non-cancer pain. Also, RSD is considered "neuropathic" or "nerve-damage" pain which is thought to be less responsive to narcotics than the other medicines listed above. The main problem is that when taken long-term, tolerance usually develops and they lose effectiveness. They cannot be stopped suddenly without a withdrawal syndrome and have a variety of side effects.
- b) NSAIDs - non-steroidal anti-inflammatory drugs.
- These are helpful only in the myofascial aspects of RSD, ie pain in the muscles of the shoulders and low back. They are also helpful in bone pain and after a new injury. The most common and limiting side effect is irritation. Common NSAIDS include:
- ibuprofen (Motrin, Advil)
- naproxen (Naprosyn)
- ketoprofen(Orudis)
- ketorolac (Toradol)
- diclofenac (Voltaren)
DRUGS COMMONLY USED BY RSD PATIENTS
Compiled by Linda Jones and Helen Small
This survey was compiled using information from RSD patients. It is intended to be used as a reference for RSD patients and as a starting point for discussion with their physicians. It is not intended as a substitute for consultation with your doctor. Please consult your doctor before taking any of these drugs.
| Generic/trade Name | Purpose | Type/Actions |
| Alprazolam | promotes sleep | sedative |
| Xanax | sleep | psychotropic agent |
| Amitriptyline | antidepressant | |
| Elavil/Endep | for sleep, depression | |
| Carbamazepine | for pain | neurological agent |
| Tegretol | anti-convulsant | psychotropic agent |
| Carisoprodol Rela/Soma | muscle pain | muscle relaxant |
| Clonazepam | for pain | neurological agent |
| Klonopin | tremors | psychotropic agent |
| Clonidine//Catapres | for pain | cardiovascular agent |
| Clonidine | for pain | anti-hypertensive |
| Codeine | for pain | analgesic/opiate agent |
| Diazepam/Valium | promote sleep | musculosketal muscle relaxant |
| Dibenzyline/Phenoxybenza | increases blood flow | anti-hypertensive |
| Diclofenac/Voltaren | for pain | musculoskeletal agent |
| Daflam | | NSAID, anti-inflammatory |
| Diflunisal/Dolobid | for pain | analgesic agent |
| Dilantin/Phenytoin | for pain | anti-convulsant |
| Doxepin/Sinequan | pain, insommnia, depression | TCA |
| Felodipene | increases blood flow | calcium channel blocker |
| Fentanyl/Duragesic | for pain | analgesic agent |
| Oralet/Sublimaze | | opiate agonist |
| Fluoxetine/Prozac | for sleep | anti-depressant |
| Hydrocodone/Vicodin | for pain | analgesic/opiate agent |
| Hydromorphone/Dilaudid | for pain | analgesic/opiate agent |
| Idarac/Floctafenine | swelling, stiffness | analgesic, anti-inflammatory |
| Imitrex/Sumetriptan | for migraines | injectible |
| Isemil | reduces hypersen | anesthetic |
| Ketoprofen/Actron | for muscle pain | analgesic agent |
| Ketorolac/Toradol | for pain | analgesic agent |
| Lodine/Etodolac | pain, swelling in joints | anti-inflammatory |
| Melatonin | promotes sleep | natural remedy (health food) |
| Mepergan | pain relief | narcotic |
| Fortis | | schedule drug |
| Meperidine/Demerol | for pain | analgesic agent opiate agonist |
| MS Contin | for pain | narcotic |
| MSIR | for breakthrough pain | morphine sulphate |
| Nabumetone/Relafen | for pain | analgesic agent |
| Nifedipine/Procardia | relaxes blood vessels | calcium channel blocker |
| Adalat | increases blood flow | cardiovascular agent |
| Nizatidine | muscle spasm,tremor | muscle relaxant |
| Nortriptyline/Pamelor | for sleep, pain | psychotropic agent, TCA |
| Oxycodone/Roxicodone | for pain | narcotic analgesic agent |
| Oxycontin | for pain | time release opiod |
| Paroxetine/Paxil | for sleep | SSRI anti-depressant |
| Pentoxifylline/Trental | for pain | hematological agent |
| Prochlorpera/Compazine | nausea | gastrointestinal agent |
| Sertraline/Zoloft | for sleep | anti-depressant |
| Stadol/Butorphanol | for pain | opiod agonist |
| Temazepam/Restoril | for sleep | psychotropic agent, anxiolytic |
| Tramadol/Ultram | for pain | analgesic agent |
| Trazodone/Desyrel | sleep, pain | SSRI anti-depressant |
| Venlafaxine/Effexor | for pain, sleep | anti-depressant |
| Wellbutrin | for pain, sleep | anti-depressant |
| Zolpidem/Ambien | for sleep | hypnotic, sedative |
DISCLAIMER:The Reflex Sympathetic Dystrophy Network offers this page for information only and does not advocate any particular course of treatment for RSD. The information on this page has been written by or compiled by the listed authors and is offered as is. It is strongly recommended that you consult your doctor before beginning any course of treatment. Some of the medications listed herein are available over the counter and no studies have been done about their efficacy in treating RSD.
We are currently working on an update to this medication information page. If you are taking any prescription medications for RSD that are not on this list, won't you please help us by letting us know? We will be using the information that you provide to update the drug list and will not collect or use any personal information about you. We appreciate your help. Click here for form.