{"id":9110,"date":"2026-08-11T05:03:51","date_gmt":"2026-08-11T05:03:51","guid":{"rendered":"https:\/\/majistraleczacilari.org.tr\/?post_type=docs&p=2453"},"modified":"2026-08-21T11:51:12","modified_gmt":"2026-08-21T11:51:12","password":"","slug":"complex-regional-pain-synd","status":"publish","type":"docs","link":"https:\/\/majistraleczacilari.org.tr\/en\/dokumanlar\/local-anesthetic-analgesic\/complex-regional-pain-synd\/","title":{"rendered":"Complex Regional Pain Synd."},"content":{"rendered":"
\"\"<\/div>\n
<\/div>\n
A disease with mysteries- <\/strong><\/div>\n
\n

Complex regional pain syndrome (CRPS) <\/strong>in the treatment of <\/strong><\/p>\n

Treatment option with magistral formula<\/strong>Complex Regional Pain Syndrome (CRPS) is a complex clinical condition presenting with severe pain, typically confined to the extremities. In addition to causing a deterioration in the individual’s quality of life, its difficult and long-term treatment also makes it socioeconomically significant. Terminologically, it is described under two clinical definitions: Type 1 (Reflex Sympathetic Dystrophy Syndrome) and Type 2 (Causalgia). Although the etiological factors of the two conditions differ, their clinical presentations are similar. With the development of the concept of neuropathic pain, different views have emerged regarding the pathophysiology of CRPS, and it has come to be described as pain of a mixed character. Accordingly, non-invasive and invasive approaches targeting neuropathic and nociceptive pain are applied in its management, and a multidisciplinary approach is essential.<\/p>\n

Complex Regional Pain Syndrome (CRPS) is a painful clinical condition following trauma, characterized by skin edema, trophic changes, alterations in sweating, and disturbances in blood flow regulation. The treatment of CRPS is challenging because there is a lack of clinical data demonstrating the efficacy of many treatments, and successful management partially requires a patient-specific, multidisciplinary approach.<\/p>\n

Complex Regional Pain Syndrome (CRPS) is a chronic pain condition believed to result from dysfunction in the central or peripheral nervous system. Its typical features include dramatic changes in the color and temperature of the skin over the affected limb or body part, accompanied by intense burning pain, skin sensitivity, sweating, and swelling. CRPS-I is frequently triggered by tissue injury; this term defines all patients who exhibit the above symptoms without an underlying nerve injury. Patients with CRPS-II present with the same symptoms, but their condition is clearly associated with a nerve injury.<\/p>\n

CRPS can occur at any age and affects both men and women. Most experts report that it is more frequent in young women.<\/p>\n

Symptoms of CRPS;
\nThe key symptom of CRPS is continuous, severe pain that worsens over time and is disproportionate to the severity of the injury (if an injury occurred). CRPS most commonly affects one of the extremities (arms, legs, hands, or feet) and is also frequently accompanied by the following:<\/p>\n

\u2022 \u201cburning\u201d pain
\n\u2022 increased skin sensitivity
\n\u2022 skin temperature changes: warmer or cooler compared to the other extremity
\n\u2022 skin color changes: usually mottled, purple, pale, or red
\n\u2022 skin texture changes: shiny and thin, and sometimes excessively sweaty
\n\u2022 changes in nail and hair growth patterns
\n\u2022 swelling and stiffness in affected joints
\n\u2022 motor deficits, with a decreased ability to move the body part.\"\"We will examine together a magistral formulation in cream form containing Dimethyl Sulfoxide, included in the Dutch National Formulary for the treatment of Complex Regional Pain Syndrome (CRPS) type I.Cr\u00e8me vaseline dimethylsulfoxide 50% FNA<\/strong><\/p>\n

Rp.<\/strong><\/p>\n

Dimethylis sulfoxidum                                50 g<\/strong><\/p>\n

Carbomerum 974P                                        1 g<\/strong><\/p>\n

Cremor vaselini cetomacrogolis FNA       46 g<\/strong><\/p>\n

Vaselinum album                                          3 g<\/strong><\/p>\n

Ingredients in the formulation:<\/strong><\/p>\n

Dimethyl sulfoxide- Dimethylsulfoxyde [DCF; FP; INN]- Dimethyli sulfoxidum [INN]- DMSO:<\/strong>Dimethyl sulfoxide (DMSO) is an extremely polar substance with exceptional properties in enhancing the solubility of organic and inorganic compounds. It is a widely used industrial solvent. It has been reported to exhibit numerous and diverse pharmacological effects, such as penetration enhancer across biological membranes, anti-inflammatory, local anesthetic, weak bacteriostatic, diuretic, vasodilator, collagen dissolver, and free radical scavenger. Due to its local anti-inflammatory effect, it is used intravesically in the symptomatic treatment of interstitial cystitis. A 50% aqueous solution is used for this purpose. It is also used in the treatment of many collagen diseases. It is included in the composition of some topical preparations applied to the skin to enhance the absorption of drugs through the skin. DMSO is available in various forms, but its purity cannot always be controlled. When topical preparations formulated with DMSO products not suitable for pharmaceutical use are applied to the skin, the impurities they contain may penetrate into the body.Carbomer- <\/strong>Polyacrylic acid- Carbomer [BAN; USAN]- Carbomer 910, 934, 934P, 940, 941, 1342 [NF 18]- Carbomere [Ph. Eur. 4; DCF]:<\/strong>Carbomer (polyacrylic acid) is a high molecular weight synthetic substance formed by cross-linking acrylic acid polymers with allyl ethers of sucrose or allyl ethers of pentaerythritol. It is a white, soft, hygroscopic powder with a faint characteristic odor. Following neutralization with alkali hydroxides or alkali amines, it is soluble in water, alcohol, and glycerol. The pH of its 1% dispersion in water is approximately 3. Carbomer is a high molecular weight, cross-linked synthetic acrylic acid polymer. Carbomer has a viscosity that does not impair optical parameters and is used to manage tear deficiency in dry eye syndrome (keratitis sicca), keratoconjunctivitis sicca, exophthalmos, lagophthalmos, and other pathological conditions leading to inadequate or impaired lubrication of the ocular surface.<\/p>\n

Within the physiological pH range of tears, carbomer maintains a viscosity that does not disrupt optical clarity. Immediately upon instillation onto the eyeball, it forms a thin layer. Due to its high viscosity, this protective and lubricating film layer formed over the cornea mixes easily with natural tears and supplements tear volume by creating a transparent, moist film over the ocular surface. Topically applied ophthalmic preparations typically contain sodium hydroxide. Through chemical interaction, sodium hydroxide in the formulation neutralizes and hydrates carbomer to form an aqueous phase. Carbomer is applied topically to the eye. Due to its high molecular weight, systemic absorption is minimal, ensuring safe use. Carbomer must be stored in tightly closed, airtight containers.Cremor vaselini cetomacrogolis FNA:<\/strong><\/p>\n

Vehicle formula included in the Dutch National Formulary;<\/strong><\/p>\n

Rp.<\/strong><\/p>\n

Anionic emulsifying wax  6.9 g<\/strong><\/p>\n

Liquid paraffin                           5.75 g<\/strong><\/p>\n

Propylene glycol                        4.6 g<\/strong><\/p>\n

White petrolatum                      13.35 g<\/strong><\/p>\n

Distilled water                               18.4 g    <\/strong><\/p>\n

Preparation of the cream:<\/strong>The different components are weighed separately. Cetomacrogol wax, liquid paraffin, and white petrolatum are heated at approximately   700<\/sup>\u00b0C. On the other hand, propylene glycol is mixed with distilled water and the mixture is heated to approximately        700<\/sup>\u00b0C. The propylene glycol-water mixture is added onto the melted mass. Stirring until the mixture cools, distilled water is added to replace the water lost due to evaporation to reach the desired weight. The cream is stored at room temperature. The shelf life is 36 months unopened and 12 months after opening.White petrolatum- Paraffin, soft, white [BP; P.Cx.79]- Petrolatum, white [NF; USP]- Vaselin, weisses [PH; Ph.Eur.]:<\/strong>Petrolatum is included in the composition of topical pharmaceutical preparations as an emollient ointment base. It is not easily absorbed through the skin. It is also used in creams, transdermal preparations, and cosmetic products. Hypersensitivity reactions associated with its topical use have been reported. Polycyclic aromatic hydrocarbon impurities it contains may cause allergic reactions. The amount of these impurities depends on the source of the petrolatum and its degree of refining. Hypersensitivity reactions caused by white petrolatum are less frequent than those caused by yellow petrolatum. For this reason, white petrolatum is preferred in cosmetic products and pharmaceutical preparations. Petrolatum is obtained from petroleum. It is a purified mixture of semi-solid saturated hydrocarbons having the general formula CnH2n+2. It is the bleached form of yellow petrolatum. It is a white, translucent, soft-consistency mass. It is odorless and tasteless. It is practically insoluble in acetone, alcohol, glycerin, and water; soluble in benzene, carbon disulfide, chloroform, ether, hexane, and numerous fixed and volatile oils. The United States Pharmacopeia (USP) permits the addition of a suitable stabilizer to its composition. It should be stored in well-closed containers in a cool and dry place. It must be protected from light.  Petrolatum is a fairly stable substance. However, it may cause stability problems due to the trace amounts of impurities it contains. These impurities can be oxidized under the influence of light to cause discoloration. Consequently, undesirable odors may develop. Such oxidations can be prevented by adding an antioxidant such as butylated hydroxyanisole, butylated hydroxytoluene, or alpha-tocopherol. It should not be heated for long periods above the temperature required to render it completely fluid (approximately 70\u00b0C).Preparation of the formula:<\/strong>Carbomer 974P is added to white petrolatum and mixed. The carbomer-petrolatum mixture is added to the cream named ‘Cremor vaselini cetomacrogolis’ in the formula and mixed. Dimethyl sulfoxide is added to the resulting mixture using geometric dilution and mixed until a homogeneous mixture is obtained. It can be stored at room temperature for 12 months.Source:<\/strong><\/p>\n

1- FNA – Formularium der Nederlandse Apothekers 2009 (Dutch National Formulary)<\/strong><\/p>\n

2-<\/strong>RxMediaPharma\u00ae2018 Interactive Drug Information Source<\/strong>Wishing you a great week\u2026<\/p>\n

Specialist Pharmacist Ahmet Nezihi Pekcan
\nPekcan Pharmacy – Konya
\npekcanecz@gmail.com
\nTel: (332) 3520657http:\/\/www.majistralformul.com\/<\/a><\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

A disease with mysteries-  Complex regional pain syndrome (CRPS) in the treatment of  Treatment option with magistral formulaComplex Regional Pain Syndrome (CRPS) is a complex clinical condition presenting with severe pain, […]<\/p>\n","protected":false},"author":1,"featured_media":2454,"comment_status":"open","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":"","_members_access_role":[],"_members_access_error":""},"doc_category":[152],"doc_tag":[],"class_list":["post-9110","docs","type-docs","status-publish","has-post-thumbnail","hentry","doc_category-local-anesthetic-analgesic"],"acf":[],"year_month":"2026-09","word_count":1630,"total_views":"1","reactions":{"happy":"0","normal":"0","sad":"0"},"author_info":{"name":"m921a","author_nicename":"m921a","author_url":"https:\/\/majistraleczacilari.org.tr\/en\/author\/m921a\/"},"doc_category_info":[{"term_name":"Local Anesthetic - Analgesic","term_url":"https:\/\/majistraleczacilari.org.tr\/en\/dokuman-kategori\/local-anesthetic-analgesic\/"}],"doc_tag_info":[],"knowledge_base_info":[],"knowledge_base_slug":[],"_links":{"self":[{"href":"https:\/\/majistraleczacilari.org.tr\/en\/wp-json\/wp\/v2\/docs\/9110","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/majistraleczacilari.org.tr\/en\/wp-json\/wp\/v2\/docs"}],"about":[{"href":"https:\/\/majistraleczacilari.org.tr\/en\/wp-json\/wp\/v2\/types\/docs"}],"author":[{"embeddable":true,"href":"https:\/\/majistraleczacilari.org.tr\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/majistraleczacilari.org.tr\/en\/wp-json\/wp\/v2\/comments?post=9110"}],"version-history":[{"count":1,"href":"https:\/\/majistraleczacilari.org.tr\/en\/wp-json\/wp\/v2\/docs\/9110\/revisions"}],"predecessor-version":[{"id":9112,"href":"https:\/\/majistraleczacilari.org.tr\/en\/wp-json\/wp\/v2\/docs\/9110\/revisions\/9112"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/majistraleczacilari.org.tr\/en\/wp-json\/wp\/v2\/media\/2454"}],"wp:attachment":[{"href":"https:\/\/majistraleczacilari.org.tr\/en\/wp-json\/wp\/v2\/media?parent=9110"}],"wp:term":[{"taxonomy":"doc_category","embeddable":true,"href":"https:\/\/majistraleczacilari.org.tr\/en\/wp-json\/wp\/v2\/doc_category?post=9110"},{"taxonomy":"doc_tag","embeddable":true,"href":"https:\/\/majistraleczacilari.org.tr\/en\/wp-json\/wp\/v2\/doc_tag?post=9110"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}