Interventions for treating pain and disability in adults with complex regional pain syndrome- an overview of systematic reviews

Ferraro, Michael C; Cashin, Aidan G; Wand, Benedict M; Smart, Keith; Berryman, Carolyn; Marston, Louise; Moseley, G. Lorimer; McAuley, James H; O’Connell, Neil E

doi:10.1002/14651858.cd009416.pub3

Cited by 9 publications

(7 citation statements)

References 340 publications

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“…This is in sharp contrast to currently employed treatment strategies in the management of CPRS patients which include a combination pharmacotherapy, multimodal physiotherapy, electrotherapy and manual lymphatic drainage, which are usually associated with a much higher financial burden and with an uncertain therapeutic efficacy. 8 , 36 …”

Section: Discussionmentioning

confidence: 99%

“…However, despite the associated burden on the quality of life, an effective therapy with strong supporting evidence lacks in this patient cohort according to the most recent Cochrane review. 8 Treatment strategies including pharmacotherapy and physical therapy have traditionally focused on pain reduction in the affected limb at the peripheral level. However, the pathophysiology of CPRS I is yet to be fully elucidated and the clinical symptoms appear to be related to abnormalities at both PNS and CNS level.…”

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confidence: 99%

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Post-polio syndrome is not a dysimmune condition

LAFFONT,

DUFLOS,

HIRTZ

et al. 2024

Eur J Phys Rehabil Med

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BACKGROUND There is growing evidence for the effectiveness of mirror therapy (MT) on pain reduction in patients with type I complex regional pain syndrome (CRPS I). AIM To evaluate the efficacy of MT on pain reduction and hand function in subjects with unilateral upper extremity CRPS I. DESIGN Randomized controlled trial with control group cross-over (half cross-over design). SETTING Subjects with CRPS I were outpatients of a university hospital and cooperating centers. All patients carried out the daily exercise at home. POPULATION Subjects with unilateral upper extremity CRPS I meeting the Budapest diagnostic criteria. METHODS Subjects were randomly divided into two groups. Group A (N.=13) carried out a ten-minute MT exercise daily, for a total duration of six weeks. Group B (N.=14) acted as a control group for six weeks followed by six weeks of MT with the same characteristics as Group A. Upper extremity active range of motion, strength, dexterity, limb volume, affected-to-unaffected hand temperature difference, and health-related quality of life were evaluated before and after each period. Daily records on the visual analogue scale were used for pain evaluation. Effectiveness was calculated using mixed-effects modelling for between-group comparisons and within-group variability, and identification of significant predictors. RESULTS Twenty-three females and four males with an average age of 56.1±9.6 years completed the study. Except for the affected-to-unaffected hand temperature difference, both groups consistently demonstrated significant or near-significant improvements in measured parameters after MT period. The improvements were evident upon an intergroup comparison of Group A and the control period of Group B as well as longitudinally within Group B. No significant improvement was found during the control period. CONCLUSIONS Principles focused on mirror visual feedback to the central nervous system can sustain promising therapeutic potential as part of the treatment for pain reduction and hand function in CRPS I patients. CLINICAL REHABILITATION IMPACT MT can be considered as part of the therapeutic regimen employed for the treatment of CRPS I.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Post-polio syndrome is not a dysimmune condition

LAFFONT,

DUFLOS,

HIRTZ

et al. 2024

Eur J Phys Rehabil Med

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“…Our meta-analysis showed BPs provided late (beyond one month) but not early (within one month) pain relief. According to the recent Cochrane review [ 37 ], there was low-quality evidence that BPs may be effective for treating pain in CRPS-I, and it was possible that pain relief might be specific to clinical signs of osteopenia or osteoporosis.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Pharmacological Treatment in Patients with Complex Regional Pain Syndrome: A Systematic Review and Meta-Analysis

Zhu,

Wen,

et al. 2024

Pharmaceuticals

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Complex regional pain syndrome (CRPS) is a disabling condition that usually affects the extremities after trauma or surgery. At present, there is no FDA-approved pharmacological treatment for patients with CRPS. We performed this systematic review and meta-analysis to evaluate the efficacy and safety of pharmacological therapies and determine the best strategy for CRPS. We searched the databases, including PubMed, Embase, Cochrane, Web of Science, Scopus, and ClinicalTrials.gov, for published eligible randomized controlled trials (RCTs) comparing pharmacological treatment with placebo in CRPS patients. Target patients were diagnosed with CRPS according to Budapest Criteria in 2012 or the 1994 consensus-based IASP CRPS criteria. Finally, 23 RCTs comprising 1029 patients were included. We used the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach to rate certainty (confidence in evidence and quality of evidence). Direct meta-analysis showed that using bisphosphonates (BPs) (mean difference [MD] −2.21, 95% CI −4.36–−0.06, p = 0.04, moderate certainty) or ketamine (mean difference [MD] −0.78, 95% CI −1.51–−0.05, p = 0.04, low certainty) could provide long-term (beyond one month) pain relief. However, there was no statistically significant difference in the efficacy of short-term pain relief. Ketamine (rank p = 0.55) and BPs (rank p = 0.61) appeared to be the best strategies for CRPS pain relief. Additionally, BPs (risk ratio [RR] = 1.86, 95% CI 1.34–2.57, p < 0.01, moderate certainty) and ketamine (risk ratio [RR] = 3.45, 95% CI 1.79–6.65, p < 0.01, moderate certainty) caused more adverse events, which were mild, and no special intervention was required. In summary, among pharmacological interventions, ketamine and bisphosphonate injection seemed to be the best treatment for CRPS without severe adverse events.

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“…These mechanisms are targeted with different pharmacologic treatment categories in order to improve treatment efficacy. [6][7][8] To personalize the management of CRPS, several subgroups have been suggested. The subgroups CRPS type 1 (without nerve lesion) and CRPS type 2 (with nerve lesion) are recognized by the IASP.…”

Section: Introductionmentioning

confidence: 99%

Different Types of Pain in Complex Regional Pain Syndrome Require a Personalized Treatment Strategy

Mangnus,

Dirckx,

Huygen

2023

JPR

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Complex regional pain syndrome (CRPS) is a debilitating painful state of an extremity that can develop after trauma. CRPS is diagnosed by the new International Association for the Study of Pain (IASP) diagnostic criteria for CRPS. The syndrome is characterized by continuing regional pain with abnormal sensory, motor, sudomotor, vasomotor, edema, and/or trophic signs. The clinical presentation of CRPS can be very heterogeneous because CRPS is a multi-mechanism syndrome. Therefore, mechanism-based subgroups have been suggested to personalize treatment for CRPS. Additionally, the presentation of symptom pain may also be able to identify different subgroups of CRPS. In this review, the types of pain recognized by the IASP―nociceptive, neuropathic, and nociplastic pain―will be discussed as possible subgroups for CRPS. Each pain type should be identified in CRPS patients, with a thorough history taking, physical examination, and diagnostic tests or (novel) biomarkers to optimize treatment effectiveness. Over the course of the syndrome, patients with CRPS probably experience more than one distinct pain type. Therefore, pain specialists should be alert to not only adjust their treatment if underlying pathophysiologic mechanisms tend to change but also to personalize the treatment of the associated type of pain in the CRPS patient.

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Interventions for treating pain and disability in adults with complex regional pain syndrome- an overview of systematic reviews

Cited by 9 publications

References 340 publications

Post-polio syndrome is not a dysimmune condition

Post-polio syndrome is not a dysimmune condition

Efficacy and Safety of Pharmacological Treatment in Patients with Complex Regional Pain Syndrome: A Systematic Review and Meta-Analysis

Different Types of Pain in Complex Regional Pain Syndrome Require a Personalized Treatment Strategy

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