Departments of PM&R and Physical Therapy and Human Movement Sciences, Northwestern University.
University of the West of England, Stapleton, Bristol, UK.
Pain Med. 2022 Jun 10;23(Suppl 1):S1-S53. doi: 10.1093/pm/pnac046.
There have been some modest recent advancements in the research of Complex Regional Pain Syndrome, yet the amount and quality of the work in this complicated multifactorial disease remains low (with some notable exceptions; e.g., the recent work on the dorsal root ganglion stimulation). The semi-systematic (though in some cases narrative) approach to review is necessary so that we might treat our patients while waiting for "better research." This semi-systematic review was conducted by experts in the field, (deliberately) some of whom are promising young researchers supplemented by the experience of "elder statesman" researchers, who all mention the system they have used to examine the literature. What we found is generally low- to medium-quality research with small numbers of subjects; however, there are some recent exceptions to this. The primary reason for this paucity of research is the fact that this is a rare disease, and it is very difficult to acquire a sufficient sample size for statistical significance using traditional statistical approaches. Several larger trials have failed, probably due to using the broad general diagnostic criteria (the "Budapest" criteria) in a multifactorial/multi-mechanism disease. Responsive subsets can often be identified in these larger trials, but not sufficient to achieve statistically significant results in the general diagnostic grouping. This being the case the authors have necessarily included data from less compelling protocols, including trials such as case series and even in some instances case reports/empirical information. In the humanitarian spirit of treating our often desperate patients with this rare syndrome, without great evidence, we must take what data we can find (as in this work) and tailor a treatment regime for each patient.
尽管复杂区域疼痛综合征的研究最近取得了一些进展,但这项复杂的多因素疾病的研究数量和质量仍然很低(也有一些显著的例外,例如最近关于背根神经节刺激的研究)。为了在等待“更好的研究”的同时治疗我们的患者,有必要采用半系统(尽管在某些情况下是叙述性的)方法进行综述。这项半系统性综述是由该领域的专家进行的(有意地),其中一些是有前途的年轻研究人员,辅以“资深政治家”研究人员的经验,他们都提到了他们用于检查文献的系统。我们发现的研究通常是数量少、质量低的研究,而且数量也很少;然而,最近也有一些例外。这种研究匮乏的主要原因是这种疾病非常罕见,而且使用传统的统计方法很难获得足够的样本量来达到统计学意义。几项大型试验都失败了,可能是因为在多因素/多机制疾病中使用了广泛的一般诊断标准(“布达佩斯”标准)。在这些大型试验中,通常可以识别出有反应的亚组,但不足以在一般诊断分组中达到统计学显著的结果。鉴于这种情况,作者不得不纳入来自说服力较弱的方案的数据,包括病例系列研究,甚至在某些情况下包括病例报告/经验信息。本着人道主义精神,我们必须根据现有的有限数据(如本研究),为每个患者制定治疗方案,来治疗这些患有这种罕见综合征的、常常绝望的患者。
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