|
1.
There was a significant difference in favour of HBOT for pain, oedema and
wrist flexion at day 45 after the start of the trial. |
Citation/s:
1. Kiralp MZ, Yildiz S, Vural D, Kesin I, Ay H, Dursun H. Effectiveness of
hyperbaric oxygen therapy in the treatment of complex regional pain syndrome.
The Journal of International Medical Research 2004; 32:258-262.
Lead author's email: mkiralp@hotmail.com
Three-part Clinical Question: For patients with early post-traumatic complex regional pain
syndrome (CRPS), does hyperbaric oxygenation result in a reduction in the
severity of symptoms and signs of the syndrome?
Search Terms: Complex regional pain syndrome; reflex sympathetic
dystrophy
The Study
Double-blinded concealed randomised controlled trial with intention-to-treat.
The Study Patients: Diagnosed with CRPS about 1.5 months after trauma to
upper limb and who had not received prior treatment.
Control group (N = 34; 34 analysed): Air at 2.4 ATA for 90 minutes daily
for 15 sessions over three weeks, plus paracetamol 500mg three times daily.
Experimental group (N = 37; 37 analysed): As above, but breathing 100%
oxygen at 2.4 ATA
The Evidence:
|
Outcome
at day 45 |
Air
Group |
HBOT
Group |
Difference |
95%
CI |
||
|
Mean |
SD |
Mean |
SD |
|
|
|
|
Visual analogue scale
for pain (0 – 10) |
5.61 |
1.37 |
3.72 |
1.42 |
1.89 |
1.23
to 2.55 |
|
wrist flexion
(degrees) |
44.55 |
16.11 |
59.86 |
17.38 |
-15.31 |
-23.26
to -7.36 |
|
Wrist circumference
(cm) |
18.2 |
0.72 |
16.98 |
0.71 |
1.22 |
0.88
to 1.56 |
Comments:
1. All patients were probably young and relatively fit at entry.
2. The HBOT was given prior to other therapy and immediately on diagnosis (1.5
months after injury).
3. We have assumed all patients had CRPS affecting the hand.
4. No measure of the functional significance of these changes. It is not clear
what the significance of 2 units of the VAS is, for example.
5. Patients did appear well matched for severity prior to therapy.
6. We have assumed no losses to follow-up, but not specifically stated in the
paper.
7. No mention of any confounders considered except age.
Appraised
by: Mike Bennett, Department of Diving and Hyperbaric Medicine, Prince of Wales
Hospital, Sydney ; Wednesday, 21 December 2005
Email: m.bennett@unsw.edu.au
Kill or Update By: December 2006