As many are aware, CRPS-1 (RSD) is now widely regarded - in its earlier stages - as a neuro-inflammatory disease. See, Neuropeptides, neurogenic inflammation and complex regional pain syndrome (CRPS), Birklein F, Schmelz M,
Neurosci Letters 2008;437:199-202, FULL TEXT @
http://www.rsds.org/2/library/articl...in_Schmelz.pdf; Differential expression patterns of cytokines in complex regional pain syndrome, Uceyler N, Eberle T, Rolke R, Birklein F, Sommer C,
Pain 2007;132:195–205, FULL TEXT @
http://www.rsds.org/2/library/articl...erle_Rolke.pdf; Intermediate stage complex regional pain syndrome type 1 is unrelated to proinflammatory cytokines, Munnikes RJ, Muis C, Boersma M, Heijmans-Antonissen C, Zijlstra FJ, Huygen FJ,
Mediators Inflamm. 2005 Dec 14;2005(6):366-72, FULL TEXT @
http://downloads.hindawi.com/journal...005/947570.pdf, Six years follow-up of the levels of TNF-alpha and IL-6 in patients with complex regional pain syndrome type 1, Wesseldijk F, Huygen FJ, Heijmans-Antonissen C, Niehof SP, Zijlstra FJ,
Mediators Inflamm. 2008;2008:469439, FULL TEXT @
http://downloads.hindawi.com/journal...008/469439.pdf.
Now, there is finally an indication that a stem cell therapy may be useful in the treatment of "neurological disorders with an inflammatory etiology." And that may fit the bill for "acute" or "intermediate" CRPS-1. Of course, there are already a number of promising treatments if the disease is diagnosed and treated early enough. See, e.g., Successful Intravenous Regional Block with Low-Dose Tumor Necrosis Factor-[Alpha] Antibody Infliximab for Treatment of Complex Regional Pain Syndrome 1, Bernateck M, Rolke R, Birklein F, Treede RD, Fink M, Karst M,
Int Anesth Res Soc. 2007;105(4):1148-1151, FULL TEXT @
http://www.rsds.org/2/library/articl...teck_Rolke.pdf; A controlled pilot study of the utility of mirror visual feedback in the treatment of complex regional pain syndrome (type 1), McCabe CS, Haigh RC, Ring EFJ, Halligan PW, Wall PD, Blake DR,
Rheumatology 2003;42:97-101, FULL TEXT @
http://www.rsds.org/2/library/articl..._Ring_etal.pdf; and perhaps the "gold standard" of early care, A unique presentation of complex regional pain syndrome type I treated with a continuous sciatic peripheral nerve block and parenteral ketamine infusion: a case report, Everett A, Mclean B, Plunkett A, Buckenmaier C,
Pain Med. 2009 Sep;10(6):1136-9. Epub 2009 Sep 9, FULL TEXT @
http://www.rsds.org/2/library/articl...n_Plunkett.pdf:
Abstract
OBJECTIVE: To successfully treat a patient with complex regional pain syndrome, refractory to standard therapy, to enable a rapid and full return to professional duties. SETTING: This case report describes the rapid resolution of an unusual presentation of complex regional pain syndrome type I after four days of treatment with a continuous sciatic peripheral nerve block and a concomitant parenteral ketamine infusion. The patient was initially diagnosed with complex regional pain syndrome (CRPS) I of the right lower extremity following an ankle inversion injury. Oral medication with naproxen and gabapentin, as well as desensitization therapy, failed to provide any relief of her symptoms. She was referred to the interventional pain management clinic. A lumbar sympathetic block failed to provide any relief. The patient was diagnosed with CRPS I and was admitted for treatment with a continuous peripheral nerve block and parenteral ketamine. CONCLUSION: This case suggests therapeutic benefit from aggressive treatment of both the peripheral and central components of CRPS.
PMID: 19744217 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/pubmed/19744217
It is my understanding that the last technique is now standard in France and Germany when CRPS-1 is initially diagnosed, as it was in the case of this 17 year old West Point Cadet. For now, however, we have to file it under "how the other half lives."
Time will tell which of these "early therapies" proves to be the most reliable and cost-effective in the long run. That and too many patients face the Catch 22 that by the time they are allowed access to more expensive therapies, due to (1) a hesitancy among carriers (WC in particular) to accept a diagnosis of CRSP-1 until the patient is exhibiting virtually all of the 1994 criteria adopted by the Committee for Classification of Chronic Pain of the International Association for the Study of Pain (IASP) and/or (2) a requirement that less expensive/novel techniques be exhausted first, the sad truth is that their conditions will have become chronic, at which point therapies built around an anti-inflammatory model will have become irrelevant. Whereupon the known possible "cures" are reduced to various forms of ketamine therapy or electroconvulsive therapy, using only the newer and safer modality: and both of those may or may not provide permanent remission for a particularly patient. Which is again unfortunate, because applied early enough, the both the anti-inflammatory and “mirror therapy and graded motor imagery” treatments appear to have higher rates of success.
In any event, here's what just popped up under the heading of stem cell therapy: Mesenchymal Stem Cells: New Approaches for the Treatment of Neurological Diseases, Momin EN, Mohyeldin A, Zaidi HA, Vela G, Quiñones-Hinojosa A,
Curr Stem Cell Res Ther. Epub 2010 Jun 9:
Department of Neurosurgery and Oncology, Brain Tumor Stem Cell Laboratory, The Johns Hopkins School of Medicine, Baltimore, MD, USA. aquinon2@jhmi.edu.
Abstract
Cellular therapies represent a new frontier in the treatment of neurological disease. Mesenchymal stem cells (MSCs), which can be harvested from bone marrow, adipose tissue, and umbilical cord blood, among many other sources, possess several qualities which may be used to treat diseases of the central nervous system. MSCs migrate to sites of malignancy, a property which may be used for the treatment of brain cancer. MSCs possess immunosuppressive properties, which may be used for the treatment of neurological disorders with an inflammatory etiology. Finally, MSCs restore injured neural tissue, a property which may be used for the treatment of neural injury. Approximately 23 clinical trials have been completed to date, with many more ongoing, and all have been listed in this review. The long-term safety of MSC-based therapies is not well established, and continues to be one major limitation to clinical translation. More broadly, only a small minority of clinical trials have employed rigorous designs that include prospective randomization, patients from multiple centers, clinically-relevant and reproducible endpoints, and adequate long-term follow-up. These limitations must be addressed before MSCs can enter widespread clinical use. Nevertheless, MSCs represent a promising new approach to treating diseases of the central nervous system that are traditionally associated with morbid outcomes. With additional pre-clinical and clinical studies that focus on their potential benefits as well as dangers, MSCs may one day find translation to clinical use in the setting of neurological disease.
PMID: 20528757 [PubMed - as supplied by publisher]
http://www.ncbi.nlm.nih.gov/pubmed/20528757
Mike