Clinical Question: Which is more effective for complex regional pain syndrome following stroke: prednisolone or piroxicam (Feldene)?

Setting: Outpatient (specialty)

Study Design: Randomized controlled trial (double-blinded)

Allocation: Concealed

Synopsis: Complex regional pain syndrome, which includes conditions such as causalgia and reflex sympathetic dystrophy, may follow stroke. The researchers identified 106 patients with this syndrome following stroke. After excluding those with diabetes, uncontrolled hypertension, heart disease, ulcer, or mild disease, there were 60 patients remaining for the study. These patients were randomized (allocation concealed) to receive piroxicam 20 mg per day or prednisolone 40 mg per day for 14 days, followed by a taper of 10 mg per week. The mean age of participants was 56 years, the age range was 40 to 70 years, and one third were women. Groups were balanced at the start of the study, and there were no dropouts. The primary outcome was a 14-point symptom score, for which 14 was the worst and 0 was the best. After one month, the score decreased from a mean of 10.7 to a mean of 4.3 in the prednisolone group but did not change significantly in the piroxicam group (from 9.8 to 9.4). An improvement of two points or more was considered clinically significant and occurred in 83 percent of patients taking prednisolone compared with 17 percent taking piroxicam (number needed to treat = 1.5)

Bottom Line: Prednisolone provides short-term pain relief in patients with complex regional pain syndrome. Longer studies are needed to assess the persistence of this benefit and to better define its risks. (Level of Evidence: 1b)