Monday, February 15, 2010

New Treatment for CRPS?

Updated 3/2017-- photos and all links (except to my own posts) removed as many no longer active. and it was easier than checking each one.

Complex Regional Pain Syndrome (CRPS) is a multi-symptom, multi-system syndrome that remain poorly understood. As I have mentioned previously , it was called reflex sympathetic dystrophy (RSD) when I first learned about it.  I still catch myself calling it RSD. 
For a complete review of CRPS, please refer to my previous post on the topic.  This post is to look at an article published in the February issue of the journal Annuals of Internal Medicine (full reference below).
A research team at the Pain Research Institute at the University of Liverpool note that there is some evidence for “for immune activation in the affected limb, peripheral blood, and cerebrospinal fluid.”
This lead them to conduct a randomized, placebo-controlled, double-blind, single-center, 2-period crossover trial study.  The study included13 eligible participants were randomly assigned between November 2005 and May 2008; 12 completed the trial.  Participants were selected from confirmed CRPS patients who had pain intensity greater than 4 on an 11-point (0 to 10) numerical rating scale and had CRPS for 6 to 30 months that was refractory to standard treatment.
They found that a single, low-dose infusion of intravenous immunoglobin (IVIG) provided significant pain relief in nearly 50 percent of patients treated.  IVIG is a blood product that contains immunoglobulin G extracts from the plasma of more than 1,000 blood donors. It is used to treat inflammatory and autoimmune diseases, immune deficiencies, and acute infections.  In this study, the pain relief lasted on average five weeks.
The editors of the Annuals make the point I want to stress:
Because the study is so small, it is difficult to know whether these results apply to most other patients with CRPS. Also, the small number of patients increases the possibility that chance may affect the results.
For now, the cornerstone in the treatment of RSD / CRPS remains normal use of the affected part as much as possible. This is done through education, pain control, and physical therapy. (photo credit)

For more information check this eMedicine article and this website (RSD Foundation). You will also find a nice video animation on the RSD Foundation site that shows how an injury might trigger RSD / CRPS.

Intravenous Immunoglobulin Treatment of the Complex Regional Pain Syndrome: A Randomized Trial;  Ann Intern Med. 2010;152:152-158; Goebel A, Baranowski A, Maurer K, Ghial A, McCabe C, Ambler G


StorytellERdoc said...

What an awesome post...and good news for the sufferers of RSD (I, like you, am having a hard time changing the name) if IVIG pans out to be an effective treatment in the future. Let's hope...

Chrysalis said...

I must have missed your older post before today. I clicked on that one and read it. I saw where one person commented on reminding doctors to think of this when it presents early and act. (Something along those lines, I read it earlier today.)

My doc still calls it RSD. I do believe early, and very fast intervention is a saving thing in breaking that loop. I can tell you that from experience. They need fast pain relief and desensitizing therapy, along with working on ROM and strength. I can't stress the desensitizing enough. You can try to work that limb all you want, but with pain that bad you can't get them to use it the way they should. This is one time where they need what ever they need to get them comfortable, so they can use the limb and lessen the guarding.

I'll be in touch, Ramona. :)

Bianca Castafiore? said...

I am grateful to see your post - thank you! I have CRPS, both type 1 and 2, in all four limbs now, as well as the lower part of my face. It's pretty awful and I find that hope is in low supply.

I truly feel that the answer -- that is, a workable approach, not a silver bullet -- will come from the work in Europe that has focused on inflammation as the major culprit in most pain syndromes.

Please, though, do remember the extremely small numbers in this study -- 'just under 50%' have substantial improvement, and that turns out to be 3 people.

But hell! Do get excited, because it is a kernel of good news for some, and it may finally hammer home the notion that research is needed in the areas of immune response and inflammation.

[The day this study was published, I went berserk on Twitter and then on my own blog. It turned out to be my typical experience of The Voyage From Ridiculous Hope To The Status Quo -- There and Back Again!} has the study available in .pdf as well as one of the best collections of reliable work being done in the field.

My frenetic response, titled "I cannot help it, I am full of hope," can be found here:

It's not that I say anything new or profound, but doctors might be interested in how news like this impacts someone with the disease.

Thank you again for your posts on CRPS/RSD. I wish more medical bloggers would mention it -- maybe the time to treatment would shorten due to heightened awareness.

doc said...

I sure hope that this can be replicated in larger trials.