Department of Anesthesiology, Centre for Pain Medicine, Erasmus MC, Rotterdam, The Netherlands.
Eur J Pain. 2022 Nov;26(10):2009-2035. doi: 10.1002/ejp.2025. Epub 2022 Sep 2.
The pathophysiology of complex regional pain syndrome (CRPS) is multifactorial, with an exaggerated inflammatory response being the most prominent. Treatment for CRPS is carried out according to the presenting pathophysiological mechanism. Anti-inflammatory treatment with glucocorticoids is therefore an option. The aim of this study was to systematically review the efficacy of glucocorticoids in CRPS.
Embase, Medline, Web of Science and Google Scholar were systematically searched for articles focusing on glucocorticoid treatment and CRPS. Screening based on title and abstract was followed by full-text reading (including reference lists) to determine the final set of relevant articles. Bias was assessed using the revised Cochrane risk-of-bias-tool for randomized trials (Rob2).
Forty-one studies were included, which reported on 1208 CRPS patients. A wide variety of glucocorticoid administration strategies were applied, with oral being the most frequently chosen. Additionally, researchers found great heterogeneity in outcome parameters, including clinical symptoms, pain relief and range of motion. The use of glucocorticoids caused an improvement of parameters in all but two studies. In particular, improvement in pain relief and range of motion were reported. Using glucocorticoids in CRPS of longer duration (i.e. more than 3 months) appears to be less effective.
Based on the present review, there is evidence to support glucocorticoid treatment in CRPS. However, the ideal administration route and dose remain unclear. We therefore recommend future research via an intervention study, as well as studies on the aetiological mechanisms and corresponding optimal treatment because CRPS pathogenesis is only partially understood.
Several studies point towards CRPS being an inflammatory response after tissue or nerve damage, with higher levels of pro-inflammatory cytokines in serum, plasma, cerebrospinal fluid and artificial skin blisters. Inflammation provides a possible role for glucocorticoids in treating CRPS. This systematic review provides a structured overview of glucocorticoid treatment in patients with CRPS. Improvement in pain and range of motion is shown. Systematic review registration number: PROSPERO-CRD42020144671.
复杂区域疼痛综合征（CRPS）的病理生理学是多因素的，其中最突出的是炎症反应过度。CRPS 的治疗是根据其表现的病理生理机制进行的。因此，抗炎治疗中使用糖皮质激素是一种选择。本研究旨在系统回顾糖皮质激素在 CRPS 中的疗效。
系统检索了 Embase、Medline、Web of Science 和 Google Scholar 中关于糖皮质激素治疗和 CRPS 的文章。首先根据标题和摘要进行筛选，然后进行全文阅读（包括参考文献），以确定最终的相关文章。使用改良后的 Cochrane 随机试验偏倚风险评估工具（Rob2）评估偏倚。
共纳入 41 项研究，报道了 1208 例 CRPS 患者。应用了各种糖皮质激素给药策略，其中口服最为常见。此外，研究人员发现，包括临床症状、疼痛缓解和运动范围在内的结局参数存在很大的异质性。除了两项研究外，使用糖皮质激素均能改善所有参数。特别是，报告了疼痛缓解和运动范围的改善。在 CRPS 病程较长（即超过 3 个月）时使用糖皮质激素效果似乎较差。
基于本综述，有证据支持糖皮质激素治疗 CRPS。然而，理想的给药途径和剂量仍不清楚。因此，我们建议未来进行干预研究以及关于发病机制和相应最佳治疗的研究，因为 CRPS 的发病机制仅部分被理解。
几项研究表明 CRPS 是组织或神经损伤后的炎症反应，血清、血浆、脑脊液和人工皮肤水疱中促炎细胞因子水平升高。炎症为糖皮质激素治疗 CRPS 提供了可能的作用机制。本系统综述提供了 CRPS 患者糖皮质激素治疗的结构化概述。结果显示疼痛和运动范围得到改善。
PROSPERO-CRD42020144671。
