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QJM Advance Access published online on January 20, 2006
QJM, doi:10.1093/qjmed/hcl004
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© The Author 2006. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: Journals.permissions@oxfordjournals.org
Received August 12, 2005
Revised November 18, 2005

Original paper

Comparison of prednisolone with piroxicam in complex regional pain syndrome following stroke: a randomized controlled trial

J. Kalita 1 *, A. Vajpayee 1, and U.K. Misra 1

1 From the Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India

* To whom correspondence should be addressed.
J. Kalita, E-mail: jkalita{at}sgpgi.ac.in or jayanteek@yahoo.com


  Abstract

Background: Complex regional pain syndrome (CRPS) following stroke aggravates morbidity. CRPS is categorized as CRPSI when no clear nerve injury is defined, and CRPSII when associated with clear nerve injury.

Aim: To compare the effect of prednisolone with that of piroxicam in patients with CRPSI following stroke.

Design: Randomized controlled trial.

Methods: Patients with CRPSI fulfilling the inclusion criteria (n = 60) underwent a detailed neurological examination, cranial CT scan, radiograph of chest and shoulder joint, blood counts and serum chemistry. Severity of stroke was assessed by the Canadian Neurological Scale (CNS), CRPS by scoring sensory, autonomic and motor symptoms, and activity of daily living by Barthel index (BI) score. Patients were randomly assigned prednisolone 40 mg or piroxicam 20 mg daily, and outcome was assessed at 1 month on the basis of CRPS and BI score.

Results: Mean patient age was 56 years and 20 were female. Baseline clinical and radiological parameters were comparable between the two groups. In the prednisolone group, 83.3% patients showed significant improvement, compared to 16.7% in the piroxicam group. The mean change in CRPS score in prednisolone group was 6.47 (95%CI 4.37-7.36), whereas in piroxicam group it was only 0.47. The mean change in BI score was 7.9 (95%CI 0.82-5.98) in the prednisolone group, and 4.5 in the piroxicam group.

Discussion: In this patient group, prednisolone resulted in significant improvement in the symptoms and signs of CRPSI following stroke, compared to piroxicam. Both drugs produced an improvement in the BI score.


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