As usual, fellow CRPSers, the offerings range from titillating in potential to near-angering regurgitation of things we've known for, oh, decades. But we must read what comes, must encourage all the efforts.
On the one hand, they are helping those who contract the syndrome in the future, and maybe we can help in the clinical trials (big toothy grin!); On that other hand, if it's working for you, we have to hope the slower researchers/fields will catch up with the rest of the research world.
First up is a disappointment:
Interventions for treating pain and disability in adults with complex regional pain syndrome.
Source
Centre for Research in Rehabilitation, School of Health Sciences and Social Care, Brunel University, Kingston Lane, Uxbridge, Middlesex, UK, UB8 3PH.
Abstract
BACKGROUND:
There is currently no strong consensus regarding the optimal management of complex regional pain syndrome although a multitude of interventions have been described and are commonly used.
OBJECTIVES:
To summarise the evidence from Cochrane and non-Cochrane systematic reviews of the effectiveness of any therapeutic intervention used to reduce pain, disability or both in adults with complex regional pain syndrome (CRPS).
METHODS:
We identified Cochrane reviews and non-Cochrane reviews through a systematic search of the following databases: Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects (DARE), Ovid MEDLINE, Ovid EMBASE, CINAHL, LILACS and PEDro. We included non-Cochrane systematic reviews where they contained evidence not covered by identified Cochrane reviews. The methodological quality of reviews was assessed using the AMSTAR tool.We extracted data for the primary outcomes pain, disability and adverse events, and the secondary outcomes of quality of life, emotional well being and participants' ratings of satisfaction or improvement. Only evidence arising from randomised controlled trials was considered. We used the GRADE system to assess the quality of evidence.
MAIN RESULTS:
We included six Cochrane reviews and 13 non-Cochrane systematic reviews. Cochrane reviews demonstrated better methodological quality than non-Cochrane reviews. Trials were typically small and the quality variable.There is moderate quality evidence that intravenous regional blockade with guanethidine is not effective in CRPS and that the procedure appears to be associated with the risk of significant adverse events.There is low quality evidence that bisphosphonates, calcitonin or a daily course of intravenous ketamine may be effective for pain when compared with placebo; graded motor imagery may be effective for pain and function when compared with usual care; and that mirror therapy may be effective for pain in post-stroke CRPS compared with a 'covered mirror' control. This evidence should be interpreted with caution. There is low quality evidence that local anaesthetic sympathetic blockade is not effective. Low quality evidence suggests that physiotherapy or occupational therapy are associated with small positive effects that are unlikely to be clinically important at one year follow up when compared with a social work passive attention control.For a wide range of other interventions, there is either no evidence or very low quality evidence available from which no conclusions should be drawn.
AUTHORS' CONCLUSIONS:
There is a critical lack of high quality evidence for the effectiveness of most therapies for CRPS. Until further larger trials are undertaken, formulating an evidence-based approach to managing CRPS will remain difficult.
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Next up is a case study. Never overlook reading case studies. The whole investigation into the Ketamine protocols derived from one case study of a woman who happened to receive ketamine for anesthesia purposes following a bad auto accident. She also had CRPS and improvement was noted in her involved limb while she was in the medically induced coma. So read those case studies!
Korean J Pain. 2013 Apr;26(2):164-8. doi: 10.3344/kjp.2013.26.2.164. Epub 2013 Apr 3.
Searching for hidden, painful osteochondral lesions of the ankle in patients with chronic lower limb pain - two case reports -.
Source
Department of Anesthesiology and Pain Medicine, School of Medicine, Pusan National University, Yangsan, Korea.
Abstract
It is easy to overlook osteochondral lesions (OCLs) of the ankle in patients with chronic lower limb pain, such as complex regional pain syndrome (CRPS) or thromboangiitis obliterans (TAO, Buerger's disease). A 57-year-old woman diagnosed with type 1 CRPS, and a 58-year-old man, diagnosed with TAO, complained of tactile and cold allodynia in their lower legs. After neurolytic lumbar sympathethic ganglion block and titration of medications for neuropathic pain, each subject could walk without the aid of crutches. However, they both complained of constant pain on the left ankle during walking. Focal tenderness was noted; subsequent imaging studies revealed OCLs of her talus and his distal tibia, respectively. Immediately after percutaneous osteoplasties, the patients could walk without ankle pain. It is important to consider the presence of a hidden OCL in chronic pain patients that develop weight-bearing pain and complain of localized tenderness on the ankle.
KEYWORDS:
ankle, cementoplasty, complex regional pain syndrome, osteochondritis dissecans, thromboangiitis obliterans
- PMID:
- 23614079
- [PubMed - in process]
- PMCID:
- PMC3629344
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Lastly, a rare occurence, worth noting:
Korean J Pain. 2013 Apr;26(2):160-3. doi: 10.3344/kjp.2013.26.2.160. Epub 2013 Apr 3.
Concurrence of malignant peripheral nerve sheath tumor at the site of complex regional pain syndrome type 1 - a case report -.
Source
Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Abstract
Malignant peripheral nerve sheath tumors (MPNSTs) are very rare sarcomas derived from various cells in the peripheral nerve sheath. Malignant peripheral nerve sheath tumors have a known association with neurofibromatosis type 1. Diagnosis of MPNSTs is difficult in patients with chronic pain, when MPNST occurs at an overlapping area of chronic pain. Therefore, the diagnosis can be missed unless clinicians pay attention to the possibility of this disease. Here in, we report a case of concurrent malignant peripheral nerve sheath tumor with complex regional pain syndrome type 1. A 44-year female patient, who was diagnosed with complex regional pain syndrome (CRPS) type 1 in her left ankle, visited our clinic because of aggravated pain. The cause of the aggravated pain was revealed as concurrent MPNST in the left common peroneal nerve territory, which overlapped the site of pain from CRPS.
KEYWORDS:
complex regional pain syndrome, nerve sheath neoplasm, neurofibromatosis
- PMID:
- 23614078
- [PubMed - in process]
- PMCID:
- PMC3629343
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