Dipyrone has analgesic, spasmolytic, and antipyretic effects and is used to treat pain. Due to a possible risk of agranulocytosis with the use of dipyrone, it has been banned in a number of countries. The most commonly used data for the use of dipyrone are related to adults. Information relating to the use of dipyrone in children is scarce. Given the potential added value of dipyrone in the treatment of pain, a review of the literature was conducted to obtain more insight into the analgesic efficacy of dipyrone in children as well as the safety of dipyrone in terms of adverse events. A literature search was done for original articles (in English, German, or Spanish language) which met the following criteria: the use of dipyrone for pain and children up to the age of 17 years old. All titles and abstracts retrieved were reviewed, independently, by two of the authors, for their suitability for inclusion. The references of the selected articles were also checked for additional relevant papers. The publications were categorized into case reports, observational studies, or randomized controlled trials. To assess the methodological quality of the studies, the Jadad score was used. In the limited available data, the analgesic efficacy of intravenous dipyrone appears similar to that of intravenous paracetamol. Evidence is lacking to support the claim that dipyrone is equivalent or even superior to Non-Steroid-Anti-Inflammatory-Drugs in pediatric pain. While the absolute risk of agranulocytosis with dipyrone in children, based on available literature, cannot be determined, case reports suggest that this risk is not negligible.
The immune system has long been thought to be involved in the pathophysiology of complex regional pain syndrome (CRPS). However, not much is known about the role of the immune system and specifically T-cells in the onset and maintenance of this disease. In this study, we aimed to evaluate T-cell activity in CRPS by comparing blood soluble interleukin-2 receptor (sIL-2R) levels between CRPS patients and healthy controls. CRPS patients had statistically significant elevated levels of sIL-2R as compared to healthy controls (median sIL-2R levels: 4151 pg/ml (Q3 − Q1 = 5731 pg/ml − 3546 pg/ml) versus 1907 pg/ml (Q3 − Q1: 2206 pg/ml − 1374 pg/ml), p < 0.001, resp.). Furthermore, sIL-2R level seems to be a good discriminator between CRPS patients and healthy controls with a high sensitivity (90%) and specificity (89.5%). Our finding indicates increased T-cell activity in patients with CRPS. This finding is of considerable relevance as it could point towards a T-cell-mediated inflammatory process in this disease. This could pave the way for new anti-inflammatory therapies in the treatment of CRPS. Furthermore, sIL-2R could be a promising new marker for determining inflammatory disease activity in CRPS.
Complex regional pain syndrome (CRPS) is a clinical disorder that is characterized by severe, continuous pain in the affected extremity, which is accompanied by sensory, vasomotor, sudomotor/oedema, and motor/trophic changes. 1. The pain is regionally restricted (i.e. cannot be related to a specific dermatome) and disproportionate to the inciting event. 1,2 CRPS is usually precipitated by trauma (mostly fractures) or surgery. 2,3 The upper extremity is affected more often than the lower extremity. 2-4 CRPS is usually limited to one extremity, though cases of CRPS in multiple extremities have been described. 2 The incidence of CRPS has been reported to range from 5.5 to 26.2 per 100 000 person-years. 3,5 Women are more frequently affected than men, with studies reporting a three-to four-fold higher incidence in women. 3,5 The highest incidence was found in women aged 61-70 yr. 3 Two distinctive forms of CRPS are currently described in the literature: CRPS type I where there is no demonstrable nerve lesion and CRPS type II where there is demonstrable nerve lesion. 1,4,6 CRPS types I and II do not differ in clinical presentation and the choice of treatment. 7 Consequently, CRPS will be used as a general term in this article referring to both CRPS type I and CRPS type II. CRPS can have a severe impact on the quality of life of patients and can lead to substantial physical and social disability. 8,9 It is therefore important for clinicians to recognize and diagnose this disorder in order to provide appropriate care and guidance to patients suffering from this debilitating disease. Key points • Complex regional pain syndrome (CRPS) is a post-traumatic disorder characterized by a nondermatomal distributed, severe, continuous pain in the affected limb and is associated with sensory, motor, vasomotor, sudomotor, and trophic disturbances.
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