Efficacy and safety of a single intrathecal methylprednisolone bolus in chronic complex regional pain syndrome.
ABSTRACT Activated immune cells in the spinal cord may play an important role in the development and maintenance of neuropathic pain, such as occurs in response to peripheral inflammation or tissue injury. Immune activation may therefore serve as a therapeutic target for immune modulating drugs like corticosteroids. This double-blind randomized placebo-controlled parallel-group trial aimed to investigate the efficacy and safety of a single intrathecal administration of 60 mg methylprednisolone (ITM) in chronic patients with complex regional pain syndrome (CRPS). The primary outcome measure was change in pain (pain intensity numeric rating scale; range 0-10) after 6 weeks. With 21 subjects per group the study had a 90% power to detect a clinically relevant difference (> or = 2 points). After 21 patients (10 on ITM) were included, the trial was stopped prematurely after the interim analysis had shown that ITM had no effect on pain (difference in mean pain intensity numeric rating scale at 6 weeks 0.3, 95% confidence interval -0.7 to 1.3) or any other outcome measure. We did not find any difference in treatment-emergent adverse events between the ITM and placebo group. We conclude that a single bolus administration of ITM is not efficacious in chronic CRPS patients, which may indicate that spinal immune activation does not play an important role in this phase of the syndrome.
Article: Current Concepts in Adult CRPS
Conference Paper: EM-based multiuser detections for optical CDMA networks[Show abstract] [Hide abstract]
ABSTRACT: We introduce several EM-based multiuser detectors for an optical CDMA system. The detectors have soft and hard stages. In the soft stage, a soft estimation of the interference is obtained by solving an unconstrained maximum-likelihood (ML) problem via an iterative expectation-maximization (EM) algorithm. Then, the hard stage detects the user information bit by solving a one-dimensional Boolean constrained problem conditioned on knowing the interference. Our results reveal that the proposed detectors have very low complexity and are robust against changes in parameters. Moreover. the numerical results illustrate that, despite their simplicity, our detectors substantially outperform other well-known suboptimum detectors, such as multistage and decorrelating detectors.Spread Spectrum Techniques and Applications, 2002 IEEE Seventh International Symposium on; 02/2002
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ABSTRACT: In Complex Regional Pain Syndrome (CRPS) related dystonia, compelling evidence points at involvement of the central nervous system, but the underpinning pathobiology is still unclear. Thus, to enable a hypothesis-free, unbiased view of the problem and to get new insight into the pathobiology of dystonia in CRPS we have applied an exploratory metabolomics analysis of cerebrospinal fluid (CSF) of patients with CRPS related dystonia. (1)H-NMR spectroscopy in combination with multivariate modeling were employed to investigate metabolic profiles of a total of 105 CSF samples collected from patients with CRPS related dystonia and controls. We found a significantly different metabolic profile of CSF in CRPS patients as compared to controls. The differences are reflected already in the first two principle components of the PCA model which is an indication that the variance associated with CPRS is stronger than variance caused by such classical confounders as gender, age or individual differences. A supervised analysis generated a strong model pinpointing the most important metabolites contributed to the metabolic signature of patients with CRPS related dystonia. From the set of identified discriminators, the most relevant metabolites were 2-keto-isovalerate, glucose, glutamine, lactate, which all showed increased concentrations and urea which showed decreased concentration in CRPS subjects. Our findings point at a catabolic state in chronic CRPS patients with dystonia which likely is associated with inflammation.Pain 10/2013; · 5.64 Impact Factor