Prednisone for the Early Treatment of Complex Regional Pain Syndrome After Distal Radius Fracture - a Pilot Randomized Trial
Wrist fractures are the most prevalent adult fracture. Complex regional pain syndrome (CRPS) is a common complication that can occur, leading to permanent disability and is costly to the patient and healthcare system. In addition, amidst the opioid epidemic, the risk of increased opioid use in patients with CRPS prompts the need to find viable treatment strategies. This study aims to evaluate an anti-inflammatory medication, prednisone, in the early treatment of CRPS. Patients with wrist fractures who undergo surgical treatment will be randomized to receiving placebo vs prednisone for 2 weeks. Clinical assessments in the follow up period will be compared.
• Patient is aged 19 years or older;
• Patient has a unilateral, closed, distal radius fracture confirmed by radiographs;
• The fracture is acute, within 14 days of injury;
• Patient undergoes open reduction internal fixation with volar locking plate;
• Patient is identified as at risk of developing CRPS with 2 or more of the following:
‣ Pain score on visual analogue scale (VAS) greater than or equal to 5/10 within 1 week of injury and beyond;
⁃ Centre of Epidemiologic Studies Depression (CES-D) score on presentation is greater than or equal to 16;
⁃ Patient identifies as female;
• Patient is identified as developing signs of CRPS based on the Budapest CRPS Criteria;
• Patient provides informed consent.