Thursday, July 5, 2012

"Let's be careful out there...."

I offer this because it showed up.  May I suggest, however, a good look at protocols used (or not used), and the myriad missing details, such as how the cohort was chosen.  I know, I am asking a lot from a mere abstract.  But, for chuckles, compare it with other abstracts, like this one from 2008, "Treatment of patients with complex regional pain syndrome type I with mannitol: a prospective, randomized, placebo-controlled, double-blinded study," which concludes "[t]his intervention is not more effective than placebo in reducing complaints for CRPS I patients and provides no addition to already-established interventions for CRPS I."

Sometimes I feel like a version of Sgt. Phil Esterhaus. "Let's be careful out there..." -- in that world of quick and easy, fast and loose CRPS research.

Orthopedics. 2012 Jun 1;35(6):e834-42. doi: 10.3928/01477447-20120525-21.
Four treatment strategies for complex regional pain syndrome type 1.Lee SK, Yang DS, Lee JW, Choy WS.
AbstractComplex regional pain syndrome (CRPS) poses a dilemma for many clinicians due to its unknown etiology and largely unsuccessful treatment modalities. The purpose of this study was to compare the clinical results of 4 treatment modalities for CRPS type 1. A total of 59 patients were divided into 4 groups based on treatment modality: group A, an oral nonsteroidal anti-inflammatory drug (NSAID) (n=10); group B, oral gabapentin (n=12); group C, intravenous (IV) 10% mannitol and steroid (n=11); group D, a combination of IV 20% mannitol and steroid with oral gabapentin (n=26). The patients remained under medical supervision after discharge and were evaluated either once a month or once every 2 months until final follow-up at a mean of 8 months. Patients in group A showed improvement in pain level, finger range of motion, swelling, and grip strength, without statistical significance (P=.076, P=.062, P=.312, and P=.804, respectively). Patients in group B showed significant improvement in pain level (P<.001), and patients in group C showed improvement in pain, finger range of motion, and swelling (P=.127), which rendered functional impairment unchanged. In comparison, patients in group D showed recovery of grip strength and improvement in pain level, finger range of motion, and (P<.001, P=.016, P=.031, and P=.047, respectively). Based on these results, a protocol including a combination of IV 20% mannitol and steroid with oral gabapentin is an acceptable and effective treatment for CRPS type 1.
Copyright 2012, SLACK Incorporated.

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