Background: Complex regional pain syndrome type I (CRPS-I), also called algodystrophy, is a
complex syndrome characterized by limb pain, edema, allodynia, hyperalgesia and functional
impairment of bone with a similar clinical picture of osteoporosis, including an increased release
of various pro-inflammatory neuropeptides and cytokines.
Several treatments have been proposed for CRPS-I, but due to the poor outcome of conventional
drugs and the invasiveness of some techniques, expectations are now directed towards new
resources that could be more effective and less invasive.
Objective: In the light of preclinical evidence, which underlined pulsed electromagnetic
fields’ (PEMFs) properties on osteoblasts (OBs), osteoclasts (OCs), and pathologies with an
inflammatory profile, the present review aims to investigate whether there is a rationale for the
use of PEMFs, as a combined approach, in CRPS-I.
Study Design: This review analyzed the 44 in vitro and in vivo studies published in the last
decade that focused on 2 main aspects of CRPS-I: local osteoporosis (OP) and inflammation.
Setting: Not applicable.
Methods: This review includes in vitro and in vivo studies found with a PubMed and Web
of Knowledge database search by 2 independent authors. The limits of the search were the
publication date between January 1, 2006, and January 1, 2016, and English language. In
detail, the search strategy was based on: 1) CRPS-I or algodystrophy; 2) OP, OCs, and OBs; and
3) inflammatory aspects.
Results: The included studies looked at the relationship between PEMFs and OCs (2 in vitro
studies), osteoporotic animal models (8 in vivo studies), OBs (20 in vitro studies), inflammatory
cytokines, and reactive oxygen species. They also tried to define the molecular cell pathways
involved (5 in vivo and 9 in vitro studies on inflammatory models). It was observed that PEMFs
increased OC apoptosis, OB viability, bone protein and matrix calcification, antioxidant protein,
and the levels of adenosine receptors, while it decreased the levels of pro-inflammatory
cytokines.
Limitations: Data from clinical trials are scarce; moreover, experimental conditions and PEMF
parameters are not standardized.
Conclusions: The present review underlined the rationale for the use of PEMFs in the complex
contest of CRPS-I syndrome, in combination with conventional drugs.