Article

There is currently no strong consensus regarding the optimal
management of complex regional pain syndrome although a multitude of
interventions have been described and are commonly used. OBJECTIVES: To summarise
the evidence from Cochrane and non-Cochrane systematic reviews of the
effectiveness of any therapeutic intervention used to reduce pain, disability or
both in adults with complex regional pain syndrome (CRPS). METHODS: We identified
Cochrane reviews and non-Cochrane reviews through a systematic search of the
following databases: Cochrane Database of Systematic Reviews, Database of
Abstracts of Reviews of Effects (DARE), Ovid MEDLINE, Ovid EMBASE, CINAHL, LILACS
and PEDro. We included non-Cochrane systematic reviews where they contained
evidence not covered by identified Cochrane reviews. The methodological quality
of reviews was assessed using the AMSTAR tool.We extracted data for the primary
outcomes pain, disability and adverse events, and the secondary outcomes of
quality of life, emotional well being and participants' ratings of satisfaction
or improvement. Only evidence arising from randomised controlled trials was
considered. We used the GRADE system to assess the quality of evidence. MAIN
RESULTS: We included six Cochrane reviews and 13 non-Cochrane systematic reviews.
Cochrane reviews demonstrated better methodological quality than non-Cochrane
reviews. Trials were typically small and the quality variable.There is moderate
quality evidence that intravenous regional blockade with guanethidine is not
effective in CRPS and that the procedure appears to be associated with the risk
of significant adverse events.There is low quality evidence that bisphosphonates,
calcitonin or a daily course of intravenous ketamine may be effective for pain
when compared with placebo; graded motor imagery may be effective for pain and
function when compared with usual care; and that mirror therapy may be effective
for pain in post-stroke CRPS compared with a 'covered mirror' control. This
evidence should be interpreted with caution. There is low quality evidence that
local anaesthetic sympathetic blockade is not effective. Low quality evidence
suggests that physiotherapy or occupational therapy are associated with small
positive effects that are unlikely to be clinically important at one year follow
up when compared with a social work passive attention control.For a wide range of
other interventions, there is either no evidence or very low quality evidence
available from which no conclusions should be drawn. AUTHORS' CONCLUSIONS: There
is a critical lack of high quality evidence for the effectiveness of most
therapies for CRPS. Until further larger trials are undertaken, formulating an
evidence-based approach to managing CRPS will remain difficult.

Langue : ANGLAIS