Background: There is no study on the long-term use of prednisolone in post-stroke complex
regional pain syndrome-1 (CRPS1).
Objective: To evaluate the efficacy and safety of long-term low dose prednisolone in post-stroke
CRPS-I.
Study Design: Open-labeled randomized controlled trial.
Setting: Tertiary care teaching institute.
Methods: Seventy-seven out of 396 (19.4%) patients with stroke had CRPS-1 and 58 met the
inclusion criteria. Their clinical details and CRPS, Visual Analogue Scale (VAS), modified Rankin Scale
(mRS), and Barthel Index (BI) scores were noted. The patients were prescribed 40 mg prednisolone
for 2 weeks followed by tapering in the next 2 weeks. Patients who responded were randomly
assigned prednisolone 10 mg daily (group I) or no prednisolone (group II). They were followed up
for the first and second month of randomization and their CRPS, VAS, mRS, and BI scores were
noted. The primary outcome was improvement in CRPS score and secondary outcomes were VAS,
mRS, BI scores, and severe adverse events (SAE).
Results: Fifty-six of fifty-eight (96.5%) patients responded to the initial high dose prednisolone and
26 each were assigned group I and group II treatment. Group I patients had further improvement
in CRPS score. Fifty percent of patients in group II had deterioration at one month and needed
reinstitution of prednisolone; following which 77% of them improved in the next month. The
improvement in CRPS score paralleled the VAS score but not mRS and BI scores in the first and
second months in group I compared to group II. There was no SAE necessitating withdrawal of
prednisolone.
Limitation: The design of the study is not double blind.
Conclusion: In post-stroke CRPS-I, continuation of low dose prednisolone for 2 months is safe
and effective.
Key words: Shoulder hand syndrome, CRPS, corticosteroid, prednisolone, stroke, Visual
Analogue Scale