The Efficacy of Neuromodulation, Interventional Treatment and Unconventional Therapies in the Treatment of Complex Regional Pain Syndrome: A Systematic Review

Essa A Samuel; Khoula Ahmad; Naelijwa J Manongi; Ramkumar Rajapandian; Sajida Moti Wala; Esraa M AlEdani; Safeera Khan

doi:10.7759/cureus.74248

The Efficacy of Neuromodulation, Interventional Treatment and Unconventional Therapies in the Treatment of Complex Regional Pain Syndrome: A Systematic Review

Cureus. 2024 Nov 22;16(11):e74248. doi: 10.7759/cureus.74248. eCollection 2024 Nov.

Authors

Essa A Samuel¹, Khoula Ahmad², Naelijwa J Manongi³, Ramkumar Rajapandian⁴, Sajida Moti Wala², Esraa M AlEdani^{5

2}, Safeera Khan²

Affiliations

¹ Physical Medicine and Rehabilitation, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
² Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
³ Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Chicago, USA.
⁴ Trauma and Orthopaedics, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
⁵ Dermatology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.

Abstract

Complex regional pain syndrome (CRPS) is a chronic debilitating multisystem neuropathic pain disorder. It is characterized by continuous pain, usually out of proportion to any known tissue injury, vasomotor changes, sudomotor or edema, and motor or trophic changes. The objective of this study is to assess the efficacy of neuromodulation, interventional, and unconventional treatments for CRPS. The primary focus is pain reduction, assessed through various scales, with secondary outcomes examining effects on autonomic, sensory, motor, and psychological aspects, and quality of life. PubMed, Cochrane Library, MDPI, and ScienceDirect databases were thoroughly searched using our detailed search strategy and relevant literature compiled. Articles were assessed using our eligibility criteria and quality appraisal tools. All types of study designs were considered. Initially, 463 articles were identified; after a thorough assessment, 23 articles comprising 2307 patients were shortlisted. Neuromodulation interventions, specifically Dorsal Root Ganglion (DRG) and Spinal Cord Stimulation (SCS) demonstrated statistically significant pain reduction (43-82% and up to 70%, respectively). Both modalities demonstrate improvement in secondary outcomes and quality of life. Interventional interventions, specifically nerve blockade ranging from sympathetic, stellate ganglion, and regional nerve blocks, all demonstrate varying levels of efficacy on measured pain and secondary outcomes. Unconventional: Botulinum toxin injections through multiple delivery systems demonstrated varying levels of efficacy in treating pain and improving secondary outcomes. In conclusion, DRG stimulation and SCS, nerve blockade, and botulinum toxin all display promise in alleviating symptoms of CRPS. Definite conclusions were not made due to a lack of clinical trial data, and longer multi-year follow-up is recommended.

Keywords: chronic pain management; complex regional pain syndrome; interventional pain medicine; neuromodulation; unconventional methods.

Publication types

Review