Glucocorticoid treatment in patients with complex regional pain syndrome: A systematic review

Abstract

Background and objective The pathophysiology of complex regional pain syndrome (CRPS) is multifactorial, with an exaggerated inflammatory response being the most prominent. Treatment for CRPS is carried out according to the presenting pathophysiological mechanism. Anti‐inflammatory treatment with glucocorticoids is therefore an option. The aim of this study was to systematically review the efficacy of glucocorticoids in CRPS. Databases and data treatment Embase, Medline, Web of Science and Google Scholar were systematically searched for articles focusing on glucocorticoid treatment and CRPS. Screening based on title and abstract was followed by full‐text reading (including reference lists) to determine the final set of relevant articles. Bias was assessed using the revised Cochrane risk‐of‐bias‐tool for randomized trials (Rob2). Results Forty‐one studies were included, which reported on 1208 CRPS patients. A wide variety of glucocorticoid administration strategies were applied, with oral being the most frequently chosen. Additionally, researchers found great heterogeneity in outcome parameters, including clinical symptoms, pain relief and range of motion. The use of glucocorticoids caused an improvement of parameters in all but two studies. In particular, improvement in pain relief and range of motion were reported. Using glucocorticoids in CRPS of longer duration (i.e. more than 3 months) appears to be less effective. Conclusion Based on the present review, there is evidence to support glucocorticoid treatment in CRPS. However, the ideal administration route and dose remain unclear. We therefore recommend future research via an intervention study, as well as studies on the aetiological mechanisms and corresponding optimal treatment because CRPS pathogenesis is only partially understood. Significance Several studies point towards CRPS being an inflammatory response after tissue or nerve damage, with higher levels of pro‐inflammatory cytokines in serum, plasma, cerebrospinal fluid and artificial skin blisters. Inflammation provides a possible role for glucocorticoids in treating CRPS. This systematic review provides a structured overview of glucocorticoid treatment in patients with CRPS. Improvement in pain and range of motion is shown. Systematic review registration number: PROSPERO‐CRD42020144671.

The Role of Neuroinflammation in Complex Regional Pain Syndrome: A Comprehensive Review

“…Journal of Pain Research 2023:16 https://doi.org/10.2147/JPR.S423733 DovePress 3063 serum. 50,52,54,55 The elevated levels of TNF-α and IL-6 in the skin of CRPS patients persist throughout both acute and chronic stages, indicating a persistent role for cytokines in exacerbating neurogenic inflammation of CRPS. 56 Animal studies have yielded similar findings, as demonstrated by a significant upregulation of proinflammatory mediators and chemokines in the plantar, spinal dorsal horn (SDH), and DRG of rats in the chronic post-ischemia pain (CPIP) model of CRPS.…”

The efficacy of oral corticoids in treating complex regional pain syndrome: A retrospective cohort study

“…12,13 A recent review showed corticoid treatment to be successful in treating CRPS, especially regarding pain relief and improvement in range of motion. 14 However, the optimal route of administration and optimal dose are still unknown. Today, in our clinic, a standardized moderate dose regimen is conducted in patients with clinical signs of inflammation and an elevated sIL-2R level.…”

“…A recent review showed corticoid treatment to be successful in treating CRPS, especially regarding pain relief and improvement in range of motion 14 . However, the optimal route of administration and optimal dose are still unknown.…”

Effectiveness of Infliximab in Patients with Complex Regional Pain Syndrome: A Case Series

“…A recent review exhibited corticoid treatment to be effective in CRPS, especially concerning pain relief and improved movement. 12 However, longer duration of corticoid treatment is associated with a high risk of side effects. 13 Alternative treatment options are therefore necessary.…”