UNASSIGNED:本研究的目的是评估上肢复杂性区域疼痛综合征(CRPS)常用药理学方法的证据质量。
UNASSIGNED:对主要前瞻性试验进行了文献检索,这些试验报道了针对上肢的I型和II型CRPS的药物治疗。根据牛津证据水平(LOE)纳入了31项试验,并由2名独立审查员进行了评估。修改后的科尔曼方法论评分,和修订后的综合报告标准试验(CONSORT)评分。计算了科恩的卡帕系数来衡量评分者间的可靠性。
未经评估:22项OxfordLOEI和9项II级试验符合纳入标准。总的来说,牛津LOE有很高的评分者间可靠性(100%一致),修改后的科尔曼方法论评分(87%一致),和CONSORT得分(94%同意)。支持上肢CRPS治疗的证据质量最高的药物干预措施是双膦酸盐和氯胺酮。缺乏高质量证据的干预措施是三环抗抑郁药(TCA)和局部二甲基亚砜(DMSO)。尚无定论的药物是降钙素,加巴喷丁,霉酚酸酯,益生菌,类固醇,非甾体抗炎药,维生素C,和N-乙酰半胱氨酸.受益有限的药物是甘露醇,硝酸异山梨酯,胍乙啶,还有吗啡.
未经评估:根据本研究评估的证据,二膦酸盐应被视为治疗CRPS的一线药物.在慢性或难治性CRPS患者中,应该强烈考虑使用氯胺酮。急性情况下的辅助治疗应包括TCA和/或局部DMSO。
The purpose of this study was to assess the quality of evidence informing on common pharmacologic modalities used in upper extremity complex regional pain syndrome (CRPS).
A literature search was performed for primary prospective trials that reported on the pharmacologic treatment of CRPS type I and II specific to the upper extremity. Thirty-one trials were included and evaluated by 2 independent reviewers according to the Oxford Levels of Evidence (LOE), modified Coleman Methodology Score, and the revised Consolidated Standards of Reporting Trials (CONSORT) score. Cohen\'s kappa coefficient was calculated to measure interrater reliability.
Twenty-two Oxford LOE I and 9 level II trials met the inclusion criteria. Overall, there was high interrater reliability in the Oxford LOE (100% agreement), modified Coleman Methodology Score (87% agreement), and CONSORT score (94% agreement). The pharmacologic interventions with the highest quality of evidence supporting use in treatment of upper extremity CRPS were bisphosphonates and ketamine. Interventions that lack high-quality evidence are tricyclic antidepressants (TCAs) and topical dimethyl sulfoxide (DMSO). Pharmacologic agents that remain inconclusive are calcitonin, gabapentin, mycophenolate, probiotics, steroids, nonsteroidal anti-inflammatory drugs, vitamin C, and N-acetylcysteine. Agents with limited benefit are mannitol, isosorbide dinitrate, guanethidine, and morphine.
Based on the evidence evaluated in this study, bisphosphonates should be considered as a first-line medication in the treatment of CRPS. In patients presenting with chronic or refractory CRPS, strong consideration should be given for the use of ketamine. Adjunct treatment in the acute setting should include TCAs and/or topical DMSO.