Get access

Anti tumor Necrosis Factor - Alpha Adalimumab for Complex Regional Pain Syndrome Type 1 (CRPS-I): A Case Series

Authors

  • Elon Eisenberg MD,

    Corresponding author
    1. The Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
    2. Institute of Pain Medicine, Rambam Health Care Campus, Haifa, Israel
    • Address correspondence and reprint requests to: Elon Eisenberg, MD, Institute of Pain Medicine, Rambam Health Care Campus, Haifa, Israel, PO Box 9602, Haifa 31096, Israel. E-mail: e_eisenberg@rambam.health.gov.il

    Search for more papers by this author
  • Ifat Sandler MD,

    1. Institute of Pain Medicine, Rambam Health Care Campus, Haifa, Israel
    Search for more papers by this author
  • Roi Treister PhD,

    1. Institute of Pain Medicine, Rambam Health Care Campus, Haifa, Israel
    2. Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
    Search for more papers by this author
  • Erica Suzan MSc,

    1. The Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
    Search for more papers by this author
  • May Haddad MSc

    1. Institute of Pain Medicine, Rambam Health Care Campus, Haifa, Israel
    2. Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
    Search for more papers by this author

Abstract

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.

Methods

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.

Results

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).

Conclusion

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.

Ancillary