Treatment of Reflex Sympathetic Dystrophy (CRPS Type 1): A Research Synthesis of 21 Randomized Clinical Trials

• Published in: Journal of Pain and Symptom Management Vol. 21; no. 6; pp. 511 - 526
• Main Authors: Perez, Roberto S.G.M, Kwakkel, Gert, Zuurmond, Wouter W.A, de Lange, Jaap J
• Format: Book Review Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-06-2001; Elsevier Science
• Subjects: Analgesics; Analgesics - therapeutic use; Autonomic Nerve Block; Biological and medical sciences; Calcitonin - therapeutic use; complex regional pain syndrome type 1; Guanethidine - therapeutic use; Humans; Injections, Intravenous; Medical sciences; meta analysis; Neuropharmacology; pain; Palliative Care; Pharmacology. Drug treatments; randomized clinical trials; Randomized Controlled Trials as Topic; Reflex sympathetic dystrophy; Reflex Sympathetic Dystrophy - therapy; complex regional pain syndrome type 1; Reflex sympathetic dystrophy; randomized clinical trials; pain; meta analysis; Human; Analgesia; Nervous system diseases; Chemotherapy; Analgesic; Pain; Treatment; Diseases of the autonomic nervous system; Clinical trial; Bibliographic review; Metaanalysis
• ISSN: 0885-3924; 1873-6513
• DOI: 10.1016/S0885-3924(01)00282-2

A blinded meta analysis was performed on randomized clinical trials (RCT) on the medicinal treatment of reflex sympathetic dystrophy (complex regional pain syndrome type I) to assess the methodological quality and quantify the analgesic effect of treatments by calculating individual and summary effect sizes. The internal validity of 21 RCTs was investigated and the quality weighted summary effect size was calculated using a fixed effect model (Glass Δ). The methodological quality ranged from moderate to good (average 46%). Differences were found between the trials in inclusion/exclusion criteria, treatment methods, duration of treatments and trials, and measurement instruments. Statistical analysis was possible for four subgroups; one evaluating the analgesic effects of sympathetic suppressors in general (
n = 12), one subgroup concerning the analgesic effects of guanethidine (
n = 6), one investigating the analgesic effect of intravenous regional sympathetic blocks (
n = 9), and one subgroup (
n = 5) evaluating the analgesic effect of calcitonin. Except for the calcitonin subgroup (
P = 0.002), the quality-weighted summary effect size of these subgroups were not significant. No significant analgesic effect by sympathetic suppressing agents could be established. Calcitonin seems to provide effective pain relief in reflex sympathetic dystrophy patients. The results of the present study show that weighting methodological quality influences the magnitude of the effect sizes of specific treatment methods. Future studies should control for methodological quality.