Complex regional pain syndrome is a
debilitating chronic pain condition causing intense pain particularly in
the arms, hands, legs, or feet. This syndrome is characterized by pain,
swelling, vasomotor instability, limited range of motion, skin color
changes and patchy bone demineralization. CRPS is often regarded to be
caused as a result of malfunction of failure of peripheral and central
nervous system and therefore also sometimes referred as reflex
sympathetic dystrophy syndrome. Complex regional pain syndrome (CRPS) is
classified into two similar forms termed as CRPS type 1 (Reflex
Sympathetic Dystrophy or RSD) and CRPS type 2 (Causalgia). The former
type mentioned has been used for individuals with confirmed nerve
injuries while the latter type is used to refer patients without any
confirmed nerve injury.
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It is noteworthy to mention that the
disease prevalence is very low and therefore classified as an orphan
disease. Furthermore, since the sympathetic nervous systems affect
several systems simultaneously, development of drugs for treating
complex regional pain syndrome had been painstaking task for the
researchers. However, the expanding knowledge base in neurology and
medicine provides unique and underserved market opportunity for drugs
and products in complex regional pain syndrome disease.
Presently there is no cure for the
disease but drug therapies help in alleviating the pain associated with
the disease as wells reduce the progression of the disease. Multimodal
therapy is prescribed for the treatment of chronic regional pain
syndrome which includes psychotherapy, rehabilitation therapy and drug
therapy. Drug therapy for CRPS includes non-steroidal anti-inflammatory
drugs (aspirin, ibuprofen, and naproxen) used to treat moderate pain
while corticosteroids such as prednisolone and methylprednisolone are
prescribed to treat inflammation and edema in the early stages of CRPS.
Drugs effective in neuropathic pain are also administered to patients
with CRPS.
These drugs include gabapentin,
amitryptiline, nortryptiline and duloxetine. Other therapeutic drugs
useful in complex regional pain syndrome (CRPS) include oxytocins,
morphine, hydrocodone, vicodin, N-methyl-D-aspartate (NMDA) receptor
antagonists (dextromethorphan) and botulinum toxin injections. Several
emerging therapies are being evaluated for the treating CRPS which
include intravenous immunoglobulin (IVIG), ketamine and hyperbaric
oxygen therapy.
Administering of calcitonin
subcutaneously or by intra-nasal spray over 3-4 weeks is being studied
for benefits against CRPS disease. Similarly, the experimental therapies
such as motor cortex and deep brain stimulation are also being studied
which may provide breakthrough improvement in the CRPS treatment
therapy. Recently, Neridronate (amino bisphosphonate) has been studied
for its effects on CRPS and has demonstrated significant reduction in
symptoms. This molecule has been awarded with orphan designation status
by the FDA but has not yet approved. We can expect that this drug
molecule may enter the market upon successful completion of clinical
trials.
The National Institutes of Health (NIH)
supports research on complex regional pain syndrome through funding for
the National Institute of Neurogical Disorders and Stroke (NINDS). Some
of the companies in the global complex regional pain syndrome (CRPS)
therapeutics market which are engaged in the research and development of
pain management products for treating CRPS disease include Abiogen
Pharma S.p.A., AlgoRx Pharmaceuticals, Inc., Amgen Inc.,Bayer AG,
Celgene Corporation, Cell Targeting Technologies, CeNeS Pharmaceuticals
plc, Danish Pain Research Center, Eli Lilly & Co., Endo
Pharmaceuticals, Forest Laboratories Inc., GlaxoSmithKline plc,
GrĂ¼nenthal GmbH Johnson & Johnson, Justus Liebig University Giessen,
King Pharmaceuticals Inc., Lee\’s Pharmaceutical Holdings Limited,
National Institute of Nursing Research (NINR), NeurogesX, Inc., Pfizer,
Inc., Stichting Achmea Slachtofferhulp Samenleving, and University of
California.
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