The Treatment of Longstanding Complex Regional Pain Syndrome with Oral Steroids

Objective. Evaluate the effectiveness of oral steroids in relieving pain in patients with Complex Regional Pain Syndrome (CRPS) of more than 3 months duration. Design. Service evaluation/Open label uncontrolled trial. Setting. Two pain outpatient clinics specialized in CRPS diagnosis and treatment in the period 2009-2012. Subjects. Thirty-one patients diagnosed with CRPS with the Budapest criteria in two specialized centers, with a disease duration of more than 3 months and not responsive to standard treatment were included. Methods. Patients were treated with oral prednisolone in both centers [100 mg daily tapered by 25 mg every 4 days to zero (I 1g) pound at center 1 (C1) and 60 mg daily for 2 weeks lowered 20 mg every 4 days to zero (I 1.06g) pound at center 2 (C2)]. The average pain intensity was recorded by patients using a numeric rating scale before the treatment start, and 6 weeks after treatment onset (treatment duration was respectively 16 days and 22 days at the two centers). Results. Overall the authors observed no significant reduction in the average pain intensity (P = 0.059), but 2 patients had a consistent reduction in pain intensity with return to baseline pain levels 9 weeks after treatment onset, and 1 patient had ongoing stable pain relief of > 50%. Conclusions. This study provides indications that the efficacy of oral corticosteroids is limited in treating CRPS of more than 3 months duration who did not respond to previous treatment. Randomized controlled studies (with enriched designs), or single subject designs would be required to identify the possible existence of a patient subgroup with a specific disease profile that may benefit from a steroid treatment.