Medications not helping your CRPS? You’re not alone. We discuss pain interventions and advanced pain management options for CRPS.

In this episode of The Pain Diaries Podcast, Melbourne pain specialists Dr Nick Christelis and Dr Bradley Lewinsohn break down the most advanced injections and interventional treatments for Complex Regional Pain Syndrome (CRPS), from sympathetic nerve blocks and ketamine infusions to spinal cord and dorsal root ganglion stimulation.

Chapters:
00:00 - Start

1:20 - Welcome to The Pain Diaries Podcast. Dr Nick Christelis and Dr Bradley Lewinsohn introduce the evidence-based interventional approach to CRPS and why timing and multidisciplinary care matter.

3:10 - What not to forget. What we talk about today must form part of a 5-step treatment plan of action.

4: 24 - Understanding CRPS: The Three Drivers of Pain.Pain, autonomic, and immune components and why targeting all three is essential for success.

5:00 – Acute CRPS: Early Interventions That Matter.When and how to use sympathetic blocks and nerve root injections for acute CRPS (first 3–6 months).

6:56 - The Pain Reduction Window of Opportunity. This allows rehab

8:20 – Lumbar and Stellate Ganglion Blocks Explained.What these injections do, where they’re placed, and how image guidance improves accuracy and safety.

09:00 – Using Botox in CRPS Injections.How botulinum toxin (Botox) prolongs relief from sympathetic nerve blocks and what the research shows.

13:08 - Combining Treatments. Improves outcomes

13:50 - The Stellate Ganglion for Hand CRPS. A key relay of nerves

16:45 - What Questions To Ask Your Pain Specialist. Important considerations

17:42 – Pulse Radiofrequency (PRF): A Non-Destructive Nerve Treatment. Why PRF can provide longer relief for CRPS and how it differs from traditional radiofrequency ablation.

18:00 – Chronic CRPS: When the Pain Persists. How chronic CRPS changes the nervous system — and why treatments must shift from inflammation control to neural modulation.

23:00 – Pulse RF and Sympathetic Plexus in Chronic CRPS. Combining PRF with nerve blocks for longer-lasting results and reduced medication reliance.

24:10 – Advanced Injections and Multidisciplinary Care. How to combine psychological, physical, and interventional therapy for long-term progress.

27:30 – Neuromodulation for CRPS: Spinal Cord Stimulation. How spinal cord stimulators work, who qualifies, and what long-term success looks like.

33:30 – Dorsal Root Ganglion (DRG) Stimulation
Targeting focal CRPS pain directly at the nerve root — advantages, limitations, and patient outcomes.

36:20 – Peripheral Nerve Stimulation (PNS). A minimally invasive option for focal CRPS pain — how it’s done and who benefits.

41:10 - This is not medical advice but for education purposes

42:27 – Intrathecal Drug Delivery (Pain Pumps). How spinal drug pumps deliver medication directly to nerves, reducing systemic side effects.

46:00 – The Most Controversial Option: Amputation. When, and why, this last-resort surgery is considered for severe CRPS. Discussion of recent 2025 studies, patient satisfaction rates, and the ethical, psychological, and functional risks involved.

49:50 – The Role of Psychiatric and Psychological Support. Why mental health assessment and follow-up are critical before any extreme intervention.

54:16 – Key Takeaways: Hope and Next Steps. Why there’s always something that can be considered — and how early specialist input can change outcomes.

This episode discusses medical decision-making for complex pain conditions, including rare last-resort options such as surgical removal of an affected limb. Viewer discretion is advised.

Here is the research paper on Botox injections to the sympathetic plexus https://pmc.ncbi.nlm.nih.gov/articles/PMC2763598/

Here is the first research article on amputation we mentioned in the podcast https://rapm.bmj.com/content/r....apm/early/2025/08/17

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And finally, a reminder, the information in these videos are not intended nor implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images, and information, contained in these videos are for general information purposes only and does not replace a consultation with your own doctor/health professional.