Prevention of Complex Regional Pain Syndrome after Distal Radius Fractures: A Systematic Review

Serôdio, Inês das Neves

http://hdl.handle.net/10400.8/9621

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Authors

Serôdio, Inês das Neves

Advisor(s)

Ortiz Huerta, J. Hilario

Santamaria Vázquez, Vázquez

Abstract(s)

Background: Complex Regional Pain Syndrome (CRPS) is one of the most debilitating chronic pain disorders, and Distal Radius Fracture (DRF) is the main trigger in prevalent cases of CRPS. Purpose: To study which is the most effective intervention described in the literature in people with DRF to prevent CRPS. Study Design: This Systematic Review was designed according to PRISMA guidelines and registered in PROSPERO RD42020208309. Methods: Studies were searched on five databases and inclusion criteria were articles written in English, Portuguese and Spanish languages and published from 2013. The included articles were assessed with CASP Checklist to reduce the risk of possible bias and the data were extracted into a summary table. Results: 9 studies were selected: 2 on vitamin C administration; 1 Probiotics; 1 Aspirin intake; 1 focused in Polarized and Polychromatic Light Therapy combined with conventional treatment; 2 on an early rehabilitation program; and 2 related to CRPS prevention measures after DRF. Administration of aspirin or ingestion of probiotics proved to be an ineffective procedure to reduce the incidence of CRPS; the studies using Light Therapy combined with conventional treatment, taking Vitamin C, and an active home exercise program reported 0% incidence of CRPS. Conclusion: The current results do not provide sufficient evidence to recommend a prevention specific protocol, however, a set of guidelines was identified that could be part of a comprehensive rehabilitation approach after a DRF: taking oral vitamin C supplementation (500 mg) daily for 90 days; a specific program of initial exercises at home; and throughout the process apply change in clinical approach towards CRPS, with more focus on prevention and psychological aspects of post-traumatic pain. Future randomized clinical trials are encouraged to evaluate the optimal rehabilitation procedure, based on these guidelines, with the aim of preventing the development of CRPS after a DRF.