Effectiveness of prednisolone in complex regional pain syndrome treatment: A systematic narrative review

Abstract

Background Many patients with complex regional pain syndrome (CRPS) experience refractory pain with severe restrictions in the activities of daily living. Oral prednisolone is commonly used to treat these patients. Purpose To review previous studies assessing the effects of prednisolone in CRPS patients. Methods and Materials Articles published from January 1, 1980 to July 23, 2021 in the PubMed database were searched using the following key phrases: (prednisolone OR corticosteroid OR steroid) AND (complex regional pain syndrome OR reflex sympathetic dystrophy OR shoulder‐hand syndrome OR causalgia). Specifically, we included those articles in which oral prednisolone or corticosteroids were used to control the CRPS symptoms. Results In total, 11 articles were included, comprising 3 randomized trials, 5 single‐arm prospective observational studies, and 3 retrospective studies. Nearly all previous studies reported that oral prednisolone can effectively control the CRPS symptoms. Moreover, though 30–100 mg/day of oral prednisolone was initially administered in these studies, 30 mg/day was also found to be effective in controlling the symptoms. Although prednisolone was usually administered for 1–3 months, short‐term treatment for 1–2 weeks was also reportedly effective. Furthermore, only 0%–30% of the patients in these studies had minor side effects after prednisolone treatment. Conclusions Our review showed that prednisolone may be effective in alleviating the CRPS symptoms. To determine higher levels of evidence, a full systematic review with more highly qualified studies, such as randomized controlled trials, should be conducted in the future.

Post‐COVID‐19 vaccination arm pain diagnosed as complex regional pain syndrome: A case report

“… 2 Among the various suggested pathophysiologic mechanisms of CRPS, the increased inflammatory mediators, such as pro‐inflammatory cytokines, were reportedly a major factor in the pathophysiology of CRPS. 4 Vaccination possibly induced an immune‐mediated inflammatory response against the injected antigen in our patient. 2 A COVID‐19 vaccine‐triggered immune reaction likely caused the patient's CRPS attack.…”

“…Injuries to the extremities, such as fractures, sprains, and surgical injuries, have been commonly proposed as precipitating factors for CRPS. 3 , 4 Post‐vaccination CRPS rarely occurs, and its overall incidence is unknown. 5 , 9 According to a cohort analysis, it affected 563 among 1,232,572 women, who received the human papillomavirus vaccine.…”

“… 9 It is characterized by pain (neuropathic pain, allodynia, and hyperalgesia), autonomic abnormalities (local edema, sweating, skin temperature, and color changes), motor involvement (decreased strength and range of motion), and trophic changes. 4 Its pathophysiology remains unclear, but some mechanisms have been proposed. It is reportedly related to different factors, including central and peripheral nervous system sensitization, autonomic dysfunction, persistent neurogenic inflammatory changes, and autoimmunity.…”

“… 3 Since it is a life‐altering disease, many patients with CRPS experience refractory pain that limits their capacity to perform activities of daily living. 3 , 4 The risk factors for CRPS include a history of injury, sprain, fracture, immobilization, and surgery. 4 Injections, specifically vaccinations, have rarely been reported to cause CRPS.…”

“… 3 , 4 The risk factors for CRPS include a history of injury, sprain, fracture, immobilization, and surgery. 4 Injections, specifically vaccinations, have rarely been reported to cause CRPS. 3 , 5 …”