Treatment of complex regional pain syndrome: a review of the evidence.
OBJECTIVE
This narrative review summarizes the evidence derived from randomized controlled trials pertaining to the treatment of complex regional pain syndrome (CRPS).


METHODS
Using the MEDLINE (January 1950 to April 2009) and EMBASE (January 1980 to April 2009) databases, the following medical subject headings (MeSH) were searched: "Complex Regional Pain Syndrome", "Reflex Sympathetic Dystrophy", and "causalgia" as well as the key words "algodystrophy", "Sudeck's atrophy", "shoulder hand syndrome", "neurodystrophy", "neuroalgodystrophy", "reflex neuromuscular dystrophy", and "posttraumatic dystrophy". Results were limited to randomized controlled trials (RCTs) conducted on human subjects, written in English, published in peer-reviewed journals, and pertinent to treatment.


RESULTS
The search criteria yielded 41 RCTs with a mean of 31.7 subjects per study. Blinded assessment and sample size justification were provided in 70.7% and 19.5% of RCTs, respectively. Only biphosphonates appear to offer clear benefits for patients with CRPS. Improvement has been reported with dimethyl sulfoxide, steroids, epidural clonidine, intrathecal baclofen, spinal cord stimulation, and motor imagery programs, but further trials are required. The available evidence does not support the use of calcitonin, vasodilators, or sympatholytic and neuromodulative intravenous regional blockade. Clear benefits have not been reported with stellate/lumbar sympathetic blocks, mannitol, gabapentin, and physical/occupational therapy.


CONCLUSIONS
Published RCTs can only provide limited evidence to formulate recommendations for treatment of CRPS. In this review, no study was excluded based on factors such as sample size justification, statistical power, blinding, definition of intervention allocation, or clinical outcomes. Thus, evidence derived from "weaker" trials may be overemphasized. Further well-designed RCTs are warranted.
Tran
De Q H
DQ
Department of Anesthesia, Montreal General Hospital, McGill University, Montreal, H3G 1A4, Quebec, Canada. de_tran@hotmail.com
Duong
Silvia
S
Bertini
Pietro
P
Finlayson
Roderick J
RJ
D000818:Animals; D020918:Complex Regional Pain Syndromes / Q000628:therapy*; D004164:Diphosphonates / Q000627:therapeutic use*; D004599:Electric Stimulation Therapy / Q000379:methods; D006801:Humans; D019018:Imagery, Psychotherapy / Q000379:methods; D016032:Randomized Controlled Trials as Topic
D004164:Diphosphonates