Improvement in pain control in complex regional pain syndrome treated with buprenorphine patch and topical compounding cream containing ketamine and clonidine: A case series

Case/Program Description: Three patients with complex regional pain syndrome (CRPS) refractory to multiple treatments and medications had positive response to buprenorphine patch and topical compounded cream with ketamine and clonidine. All had been on high dose opioid medications for at least prior 6 months with consistent numerical pain scores (NPS) of 8 or greater. With the change in medications, the next 6 months demonstrated NPS in all 3 patients ranging from 3 to 5. Setting: Outpatient clinic. Results: Patient 1 is a 47-year-old woman with a 7-year history of CRPS secondary to traumatic arthropathy of left lower ankle and crush injury of foot status post multiple surgeries. She had failed therapy, long and short acting opioid regimen, and impar block. Her consistent NPS of 8 decreased to 3 or 4 on next 6 visits. Patient 2 is a 52-year-old man who suffered traumatic left ankle arthropathy secondary to plane crash 3 years prior with long term immobilization. He was transitioned from high dose fentanyl patch with short acting opioids to buprenorphine patch with compounding cream, decreasing NPS from consistently 8 to 4 or 5 over next 6 months. Patient 3 is a 70-year-old woman with right lower extremity CRPS after car accident 14 years prior leading to multiple fractures and surgeries and development of CRPS. She was on high dose methadone and was transitioned after weaning protocol. On methadone she still averaged a 9 or 10 on NPS. Post medication NPS dropped to 4 or 5 over next 6 months. Discussion: While not all patients trialed on buprenorphine and compounding cream with ketamine and clonidine, these three patients had significant improvement on this regimen. Conclusions: The combination of a buprenorphine patch with compounding cream including clonidine and ketamine may be a viable alternative treatment option for patients with refractory CRPS.