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Canadian Journal of Anesthesia/Journal canadien d'anesthésie
Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie 6/2018

01-06-2018 | Review Article/Brief Review

Treatment of complex regional pain syndrome: an updated systematic review and narrative synthesis

Authors: Silvia Duong, BScPhm, PharmD, Daniela Bravo, MD, Keith J. Todd, MD, PhD, CCFP, Roderick J. Finlayson, MD, FRCPC, De Q. Tran, MD, FRCPC

Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Issue 6/2018

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Abstract

Purpose

Although multiple treatments have been advocated for complex regional pain syndrome (CRPS), the levels of supportive evidence are variable and sometimes limited. The purpose of this updated review is to provide a critical analysis of the evidence pertaining to the treatment of CRPS derived from recent randomized-controlled trials (RCTs).

Source

The MEDLINE, EMBASE, Psychinfo, and CINAHL databases were searched to identify relevant RCTs conducted on human subjects and published in English between 1 May 2009 and 24 August 2017.

Principal findings

The search yielded 35 RCTs of variable quality pertaining to the treatment of CRPS. Published trials continue to support the use of bisphosphonates and short courses of oral steroids in the setting of CRPS. Although emerging evidence suggests a therapeutic role for ketamine, memantine, intravenous immunoglobulin, epidural clonidine, intrathecal clonidine/baclofen/adenosine, aerobic exercise, mirror therapy, virtual body swapping, and dorsal root ganglion stimulation, further confirmatory RCTs are warranted. Similarly, trials also suggest an expanding role for peripheral sympathetic blockade (i.e., lumbar/thoracic sympathetic, stellate ganglion, and brachial plexus blocks).

Conclusions

Since our prior systematic review article (published in 2010), 35 RCTs related to CRPS have been reported. Nevertheless, the quality of trials remains variable. Therefore, further research is required to continue investigating possible treatments for CRPS.
Appendix
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Metadata
Title
Treatment of complex regional pain syndrome: an updated systematic review and narrative synthesis
Authors
Silvia Duong, BScPhm, PharmD
Daniela Bravo, MD
Keith J. Todd, MD, PhD, CCFP
Roderick J. Finlayson, MD, FRCPC
De Q. Tran, MD, FRCPC
Publication date
01-06-2018
Publisher
Springer US
Published in
Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Issue 6/2018
Print ISSN: 0832-610X
Electronic ISSN: 1496-8975
DOI
https://doi.org/10.1007/s12630-018-1091-5

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