1. 2014;17;179-185Prednisolone in Complex Regional Pain Syndrome
   Retrospective Review
   Nilgun Simsir Atalay, MD, Ozlem Ercidogan, MD, Nuray Akkaya, MD, and Fusun Sahin, MD.

BACKGROUND: Although there are several studies of systemic corticosteroid therapies in various doses and various durations in complex regional pain syndrome (CRPS), the outcome measurement parameters are limited to the range of motion measurements, edema, and symptoms of CRPS.

OBJECTIVE: To investigate the effects of prednisolone on clinical symptoms, pain, hand grip strength, range of motion, as well as on functional ability and quality of life in patients who developed CRPS after traumatic upper extremity injury.

STUDY DESIGN: Retrospective evaluation.

METHODS: Forty-five patients who used prednisolone for CRPS of the upper extremity were retrospectively studied. Prednisolone was started with a dose of 30 mg and tapered by 5 mg every 3 days until discontinuation after 3 weeks. Clinical symptoms (morning stiffness, cold intolerance, shoulder pain, numbness of fingers, hyperesthesia, abnormal sweating, and cyanosis that is exacerbated by exposure to cold temperature), pain (Visual Analogue Scale-Rest [VAS-R] and VAS-Activity [VAS-A]) were reviewed. The muscle strength with grip strength (GS) (kg), lateral pinch (LP) (pound), tip-to-tip pinch (TP) (pound), and chuck pinch (CP) (pound) measurements; the joint range of motion with using third finger tip-distal crease distance (FT-DC) (cm); functional ability with Quick-Disabilities of the Arm, Shoulder and Hand (Q-DASH) score; and quality of life with Short Form-36 (SF-36) score were evaluated.

RESULTS: Mean age was 43.53 ± 11.43 years. After 3 weeks of therapy, patients showed significant improvements in clinical symptoms compared to the basal assessments (P < 0.05). The comparison of pre- and post-treatment results revealed that VAS-R, VAS-A, GS, LP, TP, CP, FT-DC, Q-DASH scores, and all SF-36 subscores were significantly improved (P < 0.05).

LIMITATIONS: The retrospective design and data collection procedure was limited to the medical records of patients.

CONCLUSION: A short-term oral prednisolone therapy significantly reduced the symptoms and signs of CRPS, and improved the functional abilities and quality of life.