Treatments
What are the treatments for Raynaud’s phenomenon?
Aims of treatment
Aims of treatment
The main aim of treatment is to make episodes of Raynaud’s phenomenon less frequent, of shorter duration and less intense/painful. If the patient is at risk of ulcers, it can also lower the frequency and gravity of such ulcers.
Non-pharmacological therapies (without medication)
What you can do
- Reduce exposure to the cold in general by wearing warm clothing, such as a scarf and hat. Any part of the body exposed to cold can trigger Raynaud’s phenomenon in the hands and feet, not just the part of the body that usually changes color or hurts.
- Avoid direct exposure of your fingers and other affected body parts to cold objects by wearing gloves, or better yet, mittens in winter. You can also wear heated mittens or gloves that can be purchased in sports stores, but this solution is more expensive and not necessarily more effective than a pair of good-quality gloves or mittens.
- Do not smoke, as smoking has adverse effects on all blood vessel.
- Avoid alcohol, as it causes the body to lose heat.
- When you experience an episode of Raynaud’s, do exercises that increase blood flow to the extremities, such as “windmill” circles with the arms.
Don’t forget to bring a list of medications you are taking to all medical appointments! Ask your health care provider if your medications can contribute to your Raynaud’s phenomenon. Some medications, such as those prescribed to treat high blood pressure or heart disease (such as beta blockers) and others taken to treat ADHD, can constrict blood vessels. Sometimes these medications can be replaced with others that are less harmful or may even reduce Raynaud’s phenomenon.
It should be noted that Raynaud’s sufferers are not at greater risk of getting frostbite.
Pharmacological therapies (with medication)
The quality of studies examining the use of medication to treat Raynaud’s phenomenon is variable. It is therefore important to maximize the use of the non-pharmacological methods explained above, as these can be very effective. Should medication become necessary, the scientific evidence appears to be the most conclusive for the following drugs:
Dihydropyridine calcium channel blockers:
The most useful and well-studied class of drugs for Raynaud’s phenomenon. They act to dilate the blood vessels. In general, we can expect an improvement of roughly 50% of the symptoms or discomfort from Raynaud’s phenomenon using this class of drugs.
Vasodilator drugs promote dilation of the blood vessels and can be used in several ways:
- Occasionally in anticipation of outdoor activities if a cold environment is expected: this works well with short-acting medications (which often last less than 12-24 hours).
- All winter long for people who suffer very frequent and uncomfortable bouts of Raynaud’s phenomenon: this works well with short-acting (less than 24 hours) or long-acting (often up to 24 hours) medications.
- Year-round in patients with very severe Raynaud’s phenomenon: this works well with short-acting (less than 24 hours) or long-acting (often up to 24 hours) medications.
Other potentially useful medications
Angiotensin-converting enzyme (ACE) inhibitors or angiotensin-converting receptor blockers (ARB)
These drugs are not very effective for Raynaud’s.
Nitroglycerin ointments
These are used by some physicians, but the risk of headache and a significant drop in pressure is too high for this option to be considered readily acceptable.
Phosphodiesterase inhibitors
Very popular and effective in improving male erectile dysfunction, these second-line medications are considered if calcium channel blockers are poorly tolerated or ineffective.
Generally speaking, if calcium channel blockers have not been effective for a patient, other classes of drugs are unlikely to be very helpful: calcium channel blockers are the most potent oral (pill or capsule form) vasodilators on the market.
Surgical approaches:
Surgical approaches, called sympathectomies (which act on the nervous system) are rarely used and results are mixed.
Pregnancy:
Women with Raynaud’s phenomenon who are considering pregnancy should discuss drug treatment with their physician.
Finally, if you have very severe Raynaud’s phenomenon with sores (ulcers) that do not heal or keep coming back, your physician may refer you to a specialized hospital for intravenous vasodilator treatments.
