Complex Regional Pain Syndrome – Review of Inflammation & Meta-analysis


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Neurology, the journal of the Academy of Neurology, has published “Inflammation in Complex Regional Pain Syndrome, a systematic review and meta-analysis” on July 1, 2013.

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The study was supported by grants from the Australian National Health and Medical Research Council, the Canadian Institute of Health Research, the Dutch consortium on CRPS and the Dutch Ministry of Economic Affairs.

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They found “a proinflammatory state in blood, blister fluid, and CSF.” Profiles differed in acute and chronic cases.

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Levels of neuropeptides in blood and blister fluids were not higher in CRPS than in controls.

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The inflammatory profile reflected a generic chronic pain state. There was no signature specific to CRPS. Chronic pain is associated with higher levels of proinflammatory activity.

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Acute cases did differ from chronic. But affected limbs did not show higher levels of inflammation than limbs that were not affected.

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Of interest, they found significant variability in concentrations of inflammatory factors which may suggest the data reflects methodological errors. Or it may suggest that CRPS is not a distinct disorder but is a collection of disorders that appear similar clinically, or the inflammatory response is not consistent, or that important clinical subgroups exist, for example hot vs cold CRPS or variations that present with significant autonomic disorders or systemic involvement.

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They noted a recent review of treatments that found little evidence that prednisolone improves symptoms of CRPS. And they note conflicting evidence for free-radical scavengers (dimethyl sulfoxide and N-acetylcysteine). They point out the latter trials were small and of mixed quality, however I have personally seen patients who respond to those treatments.

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They recommended formal, large, high quality studies to assess the efficacy of cytokine inhibitors (TNFα inhibitors) or immunosuppressive medication. They recommended more in vivo work on the immunomodulatory effects of analgesic medications such as morphine that has, in vitro, been shown to decrease the anti-inflammatory cytokine IL-10 and increase the proinflammatory IL-12 thus predisposing to more pain.

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The material on this site is for informational purposes only.

It is not a substitute for medical advice, diagnosis or treatment provided by a qualified health care provider.

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Please understand that it is not legal for me

to give medical advice without a consultation.

If you wish an appointment, please telephone my office.

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For My Home Page, click here:  Welcome to my Weblog on Pain Management!

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