The Treatment of Longstanding Complex Regional Pain Syndrome with Oral Steroids

• Published in: Pain medicine (Malden, Mass.) Vol. 17; no. 2; pp. 337 - 343
• Main Authors: Barbalinardo, Stefania, Loer, Stephan A., Goebel, Andreas, Perez, Roberto S.G.M.
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.02.2016
• Subjects: Adult; Aged; Complex regional pain syndrome; Complex Regional Pain Syndromes - diagnosis; Complex Regional Pain Syndromes - drug therapy; Complex Regional Pain Syndromes - epidemiology; Corticosteroids; Drug Administration Schedule; Female; Glucocorticoids - administration & dosage; Humans; Male; Middle Aged; Pain; Pain Management - methods; Patients; Prednisolone; Prednisolone - administration & dosage; Steroid hormones; Steroids; Steroids - administration & dosage; Time Factors; Treatment Outcome; Young Adult; Complex Regional Pain Syndrome; Steroids; Chronic Pain
• ISSN: 1526-2375; 1526-4637
• DOI: 10.1093/pm/pnv002

Abstract Objective . Evaluate the effectiveness of oral steroids in relieving pain in patients with Complex Regional Pain Syndrome (CRPS) of more than 3 months duration. Design . Service evaluation/Open label uncontrolled trial. Setting . Two pain outpatient clinics specialized in CRPS diagnosis and treatment in the period 2009–2012. Subjects . Thirty-one patients diagnosed with CRPS with the Budapest criteria in two specialized centers, with a disease duration of more than 3 months and not responsive to standard treatment were included. Methods . Patients were treated with oral prednisolone in both centers [100 mg daily tapered by 25 mg every 4 days to zero (Σ1g) at center 1 (C1) and 60 mg daily for 2 weeks lowered 20 mg every 4 days to zero (Σ1.06g) at center 2 (C2)]. The average pain intensity was recorded by patients using a numeric rating scale before the treatment start, and 6 weeks after treatment onset (treatment duration was respectively 16 days and 22 days at the two centers). Results . Overall the authors observed no significant reduction in the average pain intensity ( P = 0.059), but 2 patients had a consistent reduction in pain intensity with return to baseline pain levels 9 weeks after treatment onset, and 1 patient had ongoing stable pain relief of >50%. Conclusions . This study provides indications that the efficacy of oral corticosteroids is limited in treating CRPS of more than 3 months duration who did not respond to previous treatment. Randomized controlled studies (with enriched designs), or single subject designs would be required to identify the possible existence of a patient subgroup with a specific disease profile that may benefit from a steroid treatment.