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Cited by 244Pain Management and TreatmentAnesthesia and Pain ManagementPain Mechanisms and Treatments

Interventions for treating pain and disability in adults with complex regional pain syndrome- an overview of systematic reviews

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O'Connell, Neil E, Wand, Benedict M, McAuley, James H, Marston, Louise, Moseley, G L·2013·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd009416.pub2PMC PMC6469537
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Abstract

BACKGROUND: 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.

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  • Cochrane Reviews may be the most reliable source of evidence because of their higher quality grading.

    “previous publications have referred to the higher quality grading (high AMSTAR score) in Cochrane Reviews due to the basic criteria necessary for publication at any stage (protocol or full review) suggesting they may be the most reliable source of evidence (O'Connell 2013).”

    From Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews (2017) · cites this paper as O'Connell 2013

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Authors
O'Connell, N. E., Wand, B. M., McAuley, J. H., Marston, L., & Moseley, G. L.
Affiliations
  • Brunel University of London (GB)
  • The University of Notre Dame Australia (AU)
  • Neuroscience Research Australia (AU)
  • The Royal Free Hospital (GB)
  • University of South Australia (AU)
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2013-04-30
Issue
4
Pages
CD009416-CD009416
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd009416.pub2
PMC
PMC6469537
OpenAlex
W1525335330
Cited by
244
References
248
Citations by year
2026: 3 · 2025: 19 · 2024: 13 · 2023: 18 · 2022: 17 · 2021: 26 · 2020: 15 · 2019: 15 · 2018: 23 · 2017: 28 · 2016: 28 · 2015: 18 · 2014: 16 · 2013: 2 · 2012: 1
FWCI
4.84
Type
journal article
Language
en
Update notices
new_version (2023-06-12)
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • ResearchOnline@ND (The University of Notre Dame) (submittedVersion)
  • Brunel University Research Archive (BURA) (Brunel University London) (submittedVersion)
  • Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
Topics
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
  • Health Sciences › Medicine › Surgery › Anesthesia and Pain Management
  • Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
Keywords
complex regional pain syndrome, CRPS treatment, pain management, disability, guanethidine, bisphosphonates, calcitonin, ketamine, graded motor imagery, mirror therapy, physiotherapy, occupational therapy, quality of life, adverse events, quality of evidence, treatment effectiveness, adults
MeSH terms
Adult, Analgesics, Calcitonin, Diphosphonates, Guanethidine, Persons with Disabilities, Humans, Ketamine, Nerve Block, Review Literature as Topic, Sympatholytics, Imagery, Psychotherapy, Complex Regional Pain Syndromes, Physical Therapy Modalities, Pain Management

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