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Complex regional pain syndrome type 1: treatments ineffective

Pain-relieving drug and non-drug treatments may be offered to patients suffering from complex regional pain syndrome type 1, but they are not very effective. Others are to be avoided, as they are ineffective or even harmful.

Complex regional pain syndrome type 1 usually affects a limb and generally occurs after trauma, but sometimes there are other contributory factors. It is characterised by the occurrence of pain disproportionate to the initial trauma; this pain is continuous and excessive, sometimes causing a major disability. The condition is often associated with cutaneous, vasomotor and local circulatory disorders, and sometimes with oedema. The average age of those affected is around 40, with women in the majority. The outcome is variable: some patients recover spontaneously after a few weeks while others develop chronic pain lasting for a period of years.

No treatment is truly effective, but some can help relieve the pain. Oral corticosteroids are effective, especially during the initial months following the onset of complex regional pain syndrome, but they do cause some adverse effects. High doses of oral alendronic acid seem to have some impact, but there is scant knowledge of the adverse effects of such high doses. Calcitonin, antiepileptics, gabapentin, antidepressants and opioids have no proven efficacy. Various non-drug approaches such as physiotherapy, relaxation and biofeedback are sometimes helpful and carry little risk. Transcutaneous neurostimulation is rapidly effective and safe, but its efficacy diminishes rapidly and sessions have to take place at increasingly shorter intervals.

©Prescrire January 2010

"Complex regional pain syndrome type 1" Prescrire Int 2009; 18 (104): 267-271 (pdf, subscribers only).

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