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Pharmacological treatment in adult patients with CRPS-I: a systematic review and meta-analysis of randomized controlled trials.
- Source :
- Rheumatology; Sep2022, Vol. 61 Issue 9, p3534-3546, 13p
- Publication Year :
- 2022
-
Abstract
- Objective Several pharmacological treatments have been proposed for the treatment of complex regional pain syndrome type-I (CRPS-I) in adults, but data regarding the efficacy of various agents for this disease is scarce. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to analyse the efficacy of the various pharmacological approaches in adults with CRPS-I. Methods We systematically searched PubMed, Scopus, and Web of Science databases from the inception date to 30 June 2021 to identify placebo-controlled or active-controlled RCTs using bisphosphonates, ketamine, CSs, anti-epileptics, NSAIDs/COXIBs, opiates, antidepressants, scavengers/magnesium sulphate or IVIGs for the treatment of CRPS-I. The primary outcomes included changes in the visual analogue scale (VAS) or numeric rating scale (NRS) for pain before and after treatment. Results We included 20 placebo-controlled or active-controlled RCTs (including a total of 818 adults with CRPS-I) that used bisphosphonates (n = 7), ketamine (n = 2), CSs (n = 2), anti-epileptics (n = 1), NSAIDs/selective inhibitors of cyclooxygenase-2 (COXIBs) (n = 2), scavengers/magnesium sulphate (n = 5), or IVIGs (n = 1) to treat CRPS-I during a median follow-up of 26 weeks. Treatment with bisphosphonates showed a significant reduction in the values of the VAS/NRS pain scale compared with placebo or reference therapy (random effects weighted mean difference [WMD]: −23.8, 95% CI: −28.0 to −19.6; I <superscript>2</superscript> = 36.4%). Treatment with ketamine also documented a reduction in the values of the VAS/NRS for pain (random effects WMD: −8.27, 95% CI: −12.9 to −3.70; I <superscript>2</superscript> = 0%). Treatment with other agents did not reduce the values of the VAS/NRS assessments of pain. Conclusion This systematic review and meta-analysis supports the recommendation of parenteral bisphosphonates as the first-line agent in the treatment of CRPS-I. Trial registration Open Science Framework registries, https://osf.io/et9gu/ , osf.io/et9gu. [ABSTRACT FROM AUTHOR]
- Subjects :
- DRUG efficacy
ONLINE information services
ANTICONVULSANTS
NARCOTICS
ANTIDEPRESSANTS
MAGNESIUM sulfate
META-analysis
DIPHOSPHONATES
CONFIDENCE intervals
ADRENOCORTICAL hormones
SYSTEMATIC reviews
NONSTEROIDAL anti-inflammatory agents
TREATMENT effectiveness
KETAMINE
DESCRIPTIVE statistics
COMPLEX regional pain syndromes
MEDLINE
BONE marrow diseases
PAIN management
EDEMA
EVALUATION
ADULTS
Subjects
Details
- Language :
- English
- ISSN :
- 14620324
- Volume :
- 61
- Issue :
- 9
- Database :
- Complementary Index
- Journal :
- Rheumatology
- Publication Type :
- Academic Journal
- Accession number :
- 158846395
- Full Text :
- https://doi.org/10.1093/rheumatology/keac060