Four treatment strategies for complex regional pain syndrome type 1.
Complex 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.
Department of Orthopedic Surgery, Eulji University College of Medicine, Daejeon, Korea. sklee@ eulji.ac.kr
Sang Ki
SK
Lee
Dae Suk
DS
Yang
Jae Won
JW
Lee
Won Sik
WS
Choy
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000588:Amines / Q000008:administration & dosage*; D000700:Analgesics; D000893:Anti-Inflammatory Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D003509:Cyclohexanecarboxylic Acids / Q000008:administration & dosage*; D003907:Dexamethasone / Q000008:administration & dosage*; D004008:Diclofenac / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005260:Female; D000077206:Gabapentin; D006801:Humans; D008297:Male; D008353:Mannitol / Q000008:administration & dosage*; D008875:Middle Aged; D010147:Pain Measurement / Q000187:drug effects; D012019:Reflex Sympathetic Dystrophy / Q000175:diagnosis / Q000188:drug therapy*; D016896:Treatment Outcome; D005680:gamma-Aminobutyric Acid / Q000008:administration & dosage*
D000588:Amines; D000700:Analgesics; D000893:Anti-Inflammatory Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D003509:Cyclohexanecarboxylic Acids; D004008:Diclofenac; D008353:Mannitol; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin; D003907:Dexamethasone