may
1
2013

¿Qué tratamientos son eficaces para el tratamiento del síndrome de dolor regional complejo en los adultos?

Síndrome de dolor regional complejoSe ha publicado una revisión de la Cochrane sobre la evidencia actual de distintas intervenciones terapéuticas en el Síndrome de dolor regional complejo.
Se basa en 6 revisiones Cochrane y 13 no Cochrane que incluyeron una amplia gama de tratamientos (fármacos, Rehabilitación, Cirugía, terapias alternativas…) en la mayoría de los casos, los artículos se basaban en estudios de baja calidad.
En forma de resumen:

  • El uso ketamina iv puede reducir eficazmente el dolor, aunque también se asocia con una aumento de efectos secundarios.
  • Bifosfonatos, la calcitonina y los programas imaginería motora graduada pueden ser eficaces en el SDRC (en general), y que la terapia del espejo puede ser eficaz en SDRC tras ictus. (baja calidad)
  • La fisioterapia y la terapia ocupacional no dieron lugar a beneficios clínicamente importantes en el seguimiento a un año. (baja calidad)
  • El bloqueo de los nervios simpáticos con anestesia local, no es eficaz. (baja calidad)
  • Hay pruebas de calidad moderada de que el bloqueo regional intravenoso con guanetidina no es eficaz y puede estar asociada con complicaciones.

Mostrar resumen »

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).

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.

This record should be cited as: O’Connell NE, Wand BM, McAuley J, Marston L, Moseley GL. Interventions for treating pain and disability in adults with complex regional pain syndrome. Cochrane Database of Systematic Reviews 2013, Issue 4. Art. No.: CD009416. DOI: 10.1002/14651858.CD009416.pub2
Assessed as up to date: March 1, 2013

1 Comment+ Add Comment

  • […] Se ha publicado una revisión de la Cochrane sobre la evidencia actual de distintas intervenciones terapéuticas en el Síndrome de dolor regional complejo (prof.).  […]

Leave a comment

UA-37655059-1