Use of Oral Prednisolone and a 3-Phase Bone Scintigraphy in Patients with Complex Regional Pain Syndrome Type I

Abstract

To compare the treatment effects of a high-dose and low-dose oral steroid regimen based on changes in the radioisotope uptake ratio (RUR) observed from three-phase bone scintigraphy (TPBS) in patients with complex regional pain syndrome type I (CRPS I), we retrospectively analyzed data of 34 patients with CRPS I from traumatic brain injury and stroke. Depending on the dose of steroid administered, patients were divided into high-dose (n = 14) and low-dose steroid groups (n = 20). We compared the severity scores, Kozin’s classification scores, and RUR observed from TPBS between the two groups. There were significant changes in the severity scores and Kozin’s classification between the baseline and 2 weeks from baseline (p < 0.05), however, there were no significant differences in terms of changes in the scores, classification, or the RUR observed from TPBS at 2 weeks from baseline (p > 0.05). There were no treatment-emergent adverse events (TEAEs) such as blood pressure elevation, impaired glycemic control, or gastrointestinal disturbances. Our results indicate that the efficacy profile of a low-dose oral steroid regimen is comparable to that of a high-dose regimen in alleviating symptoms in CRPS I patients. However, additional prospective, large-scale, multi-center studies are warranted to confirm our results.

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

“…In total, 971 articles were identified as potentially relevant articles in the primary literature search (Figure 1). After reviewing the titles and abstracts and assessing their eligibility based on the full text, 11 articles were included in this review, 11–21 comprising 3 randomized trials, 15,17,18 5 single‐arm prospective observational studies, 12–14,19,20 and 3 retrospective studies 11,16,21 (Table 1).…”

“…In 2020, Park et al 21 retrospectively analyzed the data of 34 post‐stroke and post‐traumatic brain injury patients diagnosed with CRSPS‐I based on the IASP diagnostic criteria. They compared the effectiveness of high‐dose ( n = 14) and low‐dose prednisolone ( n = 20) treatment for 2 weeks.…”

“…All five prospective observational studies 12–14,19,20 received 9 stars on the Newcastle–Ottawa quality assessment scale, which is considered a high‐quality rating. Of the three retrospective studies, 11,16,21 two 11,21 received 6 stars (moderate quality), while the other 16 received 8 stars (high quality).…”

“…Regarding treatment duration, though many previous studies used prednisolone for 1–3 months, 12–15,17–19,21 short‐term (1 or 2 weeks) use of prednisolone was also reported to be significantly effective in controlling the CRPS symptoms 16,20 . To evaluate the effect of treatment duration, Kalita et al compared the effects of 1‐month and 3‐month prednisolone use.…”

“…Particularly, corticosteroids have potent anti‐inflammatory and immunomodulatory effects and are considered one of the most useful medications for managing CRPS; prednisolone is the most commonly used corticosteroid in these patients 9,10 . Several previous studies have evaluated the effectiveness of oral prednisolone in the management of CRPS symptoms 11–21 …”