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Treatment of Complex Regional Pain Syndrome Type I with Free Radical Scavengers



Treatment of Complex Regional Pain Syndrome Type I with Free Radical Scavengers



Anesthesiology Abstracts of Scientific Papers Annual Meeting ( ): Abstract No A-1367



The use of free radical scavengers is widely applied for treatment of CRPS I in the Netherlands (1,2). The aim of this study was to compare the effects of two free radical scavengers, dimethylsulfoxide 50% (DMSO) and N-acetylcystein (NAC), for treatment of CRPS I in a randomized, double-dummy controlled, double-blind trial. 145 patients, were included over a period of 24 months in two outpatient clinics of two university hospitals in The Netherlands (see table 1). Patients were randomized into two treatment groups, one was instructed to apply DMSO 50% 5 times daily to the affected extremity, the second was treated with NAC 600 mg effervescent tablets 3 times daily, both combined with placebo. Interventions were accompanied by pain medication, occupational therapy for upper extremity CRPS I and physical therapy for lower extremity CRPS I in specific circumstances. Treatment was given for 17 weeks, with possibility to continue or switch medication after this period, up to one year following the onset of treatment. The impairment level sumscore ISS (3) was the primary outcome measure. Overall, no significant differences were found between NAC and DMSO after 17 (p=0.27) and 52 weeks (p=0.38) on impairment level (see table 2). Subgroup analysis showed more favorable results for DMSO for warm CRPS I (p=0.07) and significantly better performance of NAC for patients with a cold CRPS I (p<0.01. Results tended to be negatively influenced if the duration of the complaint was longer. Treatment with DMSO and NAC are generally equally effective in treatment of CRPS I. Strong indications exist for differences in effects for subgroups of patients with warm or cold CRPS I: for warm CRPS I DMSO-treatment appears more favorable, for cold CRPS I NAC- treatment appears to be more effective. Anesthesiology 2002; 96: A1367 Journal Symposium: Mechanism-Based Diagnosis and Therapy of Chronic Pain (9:00 AM-12:30 PM).

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