Short-term treatment with parecoxib for complex regional pain syndrome

TY - JOUR

T1 - Short-term treatment with parecoxib for complex regional pain syndrome

T2 - a randomized, placebo-controlled double-blind trial

AU - Breuer, Anna J

AU - Mainka, Tina

AU - Hansel, Nora

AU - Maier, Christoph

AU - Krumova, Elena K

PY - 2014/3/25

Y1 - 2014/3/25

N2 - BACKGROUND: Complex regional pain syndrome (CRPS) is characterized by signs and symptoms of peripheral inflammation, which leads to peripheral neural sensitization associated most frequently (in about 70%) with blunt pressure hyperalgesia. Therefore, we hypothesized that treatment of CRPS patients with a selective COX-2-inhibitor would alleviate the abnormally low pressure pain threshold (PPT) and reduce pain intensity and edema.METHODS: Twenty patients with CRPS type I (n = 16) and II of the upper limb and abnormally low PPT were double-blind randomised into 2 groups of 10 patients each to receive a 2-day intravenous treatment of either 80 mg parecoxib per day (group I) or placebo (NaCl 0.9%, group II). Standardized quantitative sensory testing (QST) using the DFNS protocol was performed before and after treatment. Pain intensity (NRS 0 - 10); circumferences of the fingers II, IV, and V (mm); PPT (kPa, thenar/hypothenar); and adverse events were recorded daily.STATISTICS: Wilcoxon-test, Mann-Whitney-U-test, Friedman-test, Fisher-test, significance level: P < 0.05.STUDY DESIGN: Proof of concept trial performed in randomized, placebo-controlled, double blind style .SETTING: Pain Management Center in Germany.RESULTS: There were no group differences in PTT or other QST parameters. After treatment, PPT decreased insignificantly in group I (median [range]; before: 224.0 [121.0 - 52937] kPa, afterwards: 186.4 [101.4 - 526.5] kPa) and increased insignificantly in group II (before: 207.6 [170.0 - 320.5] kPa; afterwards: 235.4 [163.5 - 349.9] kPa). Pain scores and finger circumferences remained unchanged in both groups.LIMITATIONS: Due to difficulty in recruitment the trial was closed after inclusion of 20 patients.CONCLUSION: In the present proof-of-concept trial, short-term treatment with the selective COX-2-inhibitor parecoxib influenced neither PPT nor edema or pain. COX-2 might be less important than previously assumed. However, the results are limited due to the small number of patients, short-term treatment, and focus on the PPT, which could have led to false negative results of the present study and covered the expected therapeutic effect.

AB - BACKGROUND: Complex regional pain syndrome (CRPS) is characterized by signs and symptoms of peripheral inflammation, which leads to peripheral neural sensitization associated most frequently (in about 70%) with blunt pressure hyperalgesia. Therefore, we hypothesized that treatment of CRPS patients with a selective COX-2-inhibitor would alleviate the abnormally low pressure pain threshold (PPT) and reduce pain intensity and edema.METHODS: Twenty patients with CRPS type I (n = 16) and II of the upper limb and abnormally low PPT were double-blind randomised into 2 groups of 10 patients each to receive a 2-day intravenous treatment of either 80 mg parecoxib per day (group I) or placebo (NaCl 0.9%, group II). Standardized quantitative sensory testing (QST) using the DFNS protocol was performed before and after treatment. Pain intensity (NRS 0 - 10); circumferences of the fingers II, IV, and V (mm); PPT (kPa, thenar/hypothenar); and adverse events were recorded daily.STATISTICS: Wilcoxon-test, Mann-Whitney-U-test, Friedman-test, Fisher-test, significance level: P < 0.05.STUDY DESIGN: Proof of concept trial performed in randomized, placebo-controlled, double blind style .SETTING: Pain Management Center in Germany.RESULTS: There were no group differences in PTT or other QST parameters. After treatment, PPT decreased insignificantly in group I (median [range]; before: 224.0 [121.0 - 52937] kPa, afterwards: 186.4 [101.4 - 526.5] kPa) and increased insignificantly in group II (before: 207.6 [170.0 - 320.5] kPa; afterwards: 235.4 [163.5 - 349.9] kPa). Pain scores and finger circumferences remained unchanged in both groups.LIMITATIONS: Due to difficulty in recruitment the trial was closed after inclusion of 20 patients.CONCLUSION: In the present proof-of-concept trial, short-term treatment with the selective COX-2-inhibitor parecoxib influenced neither PPT nor edema or pain. COX-2 might be less important than previously assumed. However, the results are limited due to the small number of patients, short-term treatment, and focus on the PPT, which could have led to false negative results of the present study and covered the expected therapeutic effect.

KW - Adult

KW - Aged

KW - Complex Regional Pain Syndromes

KW - Cyclooxygenase 2 Inhibitors

KW - Double-Blind Method

KW - Edema

KW - Female

KW - Humans

KW - Hyperalgesia

KW - Isoxazoles

KW - Male

KW - Middle Aged

KW - Pain Measurement

KW - Sensory Thresholds

KW - Statistics, Nonparametric

KW - Surveys and Questionnaires

KW - Young Adult

KW - Journal Article

KW - Randomized Controlled Trial

KW - Research Support, Non-U.S. Gov't

M3 - SCORING: Journal article

C2 - 24658473

VL - 17

SP - 127

EP - 137

JO - PAIN PHYSICIAN

JF - PAIN PHYSICIAN

SN - 1533-3159

IS - 2

ER -