Anti tumor Necrosis Factor - Alpha Adalimumab for Complex Regional Pain Syndrome Type 1 (CRPS-I): A Case Series
Article first published online: 13 MAY 2013
© 2013 World Institute of Pain
Volume 13, Issue 8, pages 649–656, November 2013
How to Cite
Eisenberg, E., Sandler, I., Treister, R., Suzan, E. and Haddad, M. (2013), Anti tumor Necrosis Factor - Alpha Adalimumab for Complex Regional Pain Syndrome Type 1 (CRPS-I): A Case Series. Pain Practice, 13: 649–656. doi: 10.1111/papr.12070
- Issue published online: 8 NOV 2013
- Article first published online: 13 MAY 2013
- Manuscript Accepted: 8 MAR 2013
- Manuscript Received: 30 NOV 2011
- Abbott Laboratories S.A.
- complex regional pain syndromes;
- anti-inflammatory agents;
- tissue necrosis factor;
Background and aims
Evidence suggests tumor necrosis factor-alpha (TNF-α) mediates, at least in part, symptoms and signs in complex regional pain syndrome (CRPS). Here, we present a case series of patients with CRPS type 1, in whom the response to the anti-TNF-α adalimumab was assessed.
Ten patients with CRPS type 1 were recruited. Assessments were performed before treatment, at 1 week, and 1, 3, and 6 months following 3 biweekly subcutaneous injections (40 mg/0.8 mL) adalimumab (Humira®) and included the followings: Pain intensity using a 0–10 cm visual analog scale; the Short Form of the McGill Pain Questionnaire; the Beck Depression Inventory; the SF-36 questionnaire and mechanical and thermal thresholds (Von frey hair and Thermal Sensory Analyzer, respectively). In addition to the description of individual patient responses, both intention to treat (ITT) and per-protocol (PP) analyses were performed for the entire group.
Three subgroups of patients were identified (3 patients in each): “nonresponders”, “partial responders”, and “robust responders” in whom improvement in almost all parameters was noted. Both the ITT and PP analyses demonstrated only a trend toward improvement in mechanical pain thresholds following treatment (ITT χ² = 13.83, P = 0.008; PP χ² = 10.29, P = 0.036).
These results suggest adalimumab, and possibly other anti-TNF-α, can be potentially useful in some (although not in all) patients with CRPS type 1. These preliminary results along with the growing body of evidence which points to the involvement of TNF-α in the pathogenesis of CRPS justify further studies in this area.