Neuromodulation in Treating Complex Regional Pain Syndrome: A Critical Review of the Evidence

Background and objectives: The management of complex regional pain syndrome (CRPS) remains a challenging task therefore a large number of interventions have been investigated. Lately, invasive and non-invasive neuromodulation have been coming up as an alternative for some patients even as an add-on treatment to medicines or physical therapy. The objective of this review is to evaluate the evidence of its effectiveness in CRPS chronic pain management.

Methods: We have used key words referring to neuromodulation techniques and CRPS to select studies from Medline, Lilacs and Cochrane Library databases. All relevant articles which have described any kind of neuromodulation as CRPS primary treatment have been reviewed by two independent researchers to assign the level of evidence according to Oxford Level of Evidence. A third researcher was consulted in dubious cases to get to the final conclusion.

Results: Although a variety of methods and devices have been used, the evidences are still poor. There is no level 1 study which confers grade A of recommendation for any method of neuromodulation in the CRPS treatment. Repetitive transcranial magnetic stimulation (rTMS) over the motor cortex and spinal cord stimulation (SCS) were the techniques with the best grade of recommendation (B or C).

Conclusion: The literature still lacks high-quality evidence supporting neuromodulation effectiveness in CRPS pain treatment. We found only a few studies that had approached this issue properly. Those facts themselves were the main limitation of this study and of those that must be coming soon. High-quality multicentre trials ought to be performed for definitive conclusions.

Author(s):

Helder Picarelli, Hugo Sterman-Neto, Marcelo Lima De-Oliveira and Manoel Jacobsen Teixeira

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