Table of Contents Author Guidelines Submit a Manuscript
Case Reports in Medicine
Volume 2011, Article ID 319750, 4 pages
Case Report

Multimodal Stepped Care Approach Involving Topical Analgesics for Severe Intractable Neuropathic Pain in CRPS Type 1: A Case Report

1Institute for Neuropathic Pain, Vespuccistraat 64-III, 1056 SN Amsterdam, The Netherlands
2Institute for Neuropathic Pain, Bosch en Duin, The Netherlands

Received 21 June 2011; Accepted 14 August 2011

Academic Editor: Stephen P. Peters

Copyright © 2011 David J. Kopsky and Jan M. Keppel Hesselink. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


A multimodal stepped care approach has been successfully applied to a patient with complex regional pain syndrome type 1 and severe intractable pain, not responding to regular neuropathic pain medication. The choice to administer drugs in creams was made because of the intolerable adverse effects to oral medication. With this method, peak-dose adverse effects did not occur. The multimodal stepped care approach resulted in considerable and clinically relevant decrease in pain after every step, using topical amitriptyline, ketamine, and dimethylsulphoxide.