Pain and swelling - typically after some distal frature in senior women - several studies

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Complex Regional Pain Syndrome is associated with lower Vitamin D – Dec 2024

Vitamin D deficiency and Complex Regional Pain Syndrome
Vitamin D - Updates 2024;7(2):42-46. https://doi.org/10.30455/2611-2876-2024-3e
Massimo Varenna, Francesca Zucchi, Chiara Crotti, Raffaele Di Taranto, Francesco Orsini
Osteoporosis and Metabolic Bone Disease Unit, ASST Pini-CTO, Milan

To consider the possible relationships between vitamin D and algodystrophy syndrome, i.e. complex regional pain syndrome (CRPS), one must understand that bone tissue is a key player in the pathogenetic dynamics of the syndrome 1. In addition to the results obtained by treatment with drugs whose mechanism of action involves bone tissue as their main target, there is also much evidence supporting the fundamental role that bone has in the onset and maintenance of the disease. Aside from findings arising from diagnostic testing (osteoporosis on standard radiology, hypercaptation on scintigraphy scans, bone oedema on magnetic resonance imaging), epidemiological studies have reported that fracture is the most frequent predisposing event. Consequently, all diseases that lead to an increase in bone fragility and therefore to the incidence of fractures (postmenopausal and senile osteoporosis, osteogenesis imperfecta) are often exacerbated by an increase in the incidence of algodystrophy. As further proof of this pathogenetic link, there are reports showing that osteoporosis is present in patients with CRPS at a significantly higher prevalence than in the general population 2. Additionally, an animal model that closely reproduces human disease can been obtained by inducing a distal fracture of the tibia. Lastly, it is worth mentioning that an increase in osteoprotegerin (OPG), the molecule involved in the regulation of the RANK/RANKL system, has been implicated in the early stages of the disease.
As previously reported, in most cases, it has been ascertained that a traumatic fracture event is the most frequent predisposing factor for CRPS. In addition, the most reliable epidemiological findings 3 have shown that the peak incidence of distal radius fractures, i.e. the fracture event that is most often complicated by CRPS 4, among females and in the decade following menopause, is likely to be reflective of a similar trend within the general population. Data on the incidence following distal radius fractures in the literature vary widely (ranging from 1% to 37%). This variability can undoubtedly be attributed to the different diagnostic criteria used to document these events. The most recent studies using the diagnostic criteria adopted by the International Association for the Study of Pain (IASP), i.e. Budapest criteria, which have been recognised to be the best in terms of sensitivity and specificity, report that CRPS is present in 14% of patients who have suffered distal radius fractures 4.
It has been widely acknowledged that this type of fracture is the earliest clinical event related to osteoporosis, in that it occurs, on average, 15 years before proximal femur fractures, and that it is also a predictive event for other fragility fractures, namely vertebral fractures and proximal femur fractures 5. Among the many clinical variables identified as being predictive of distal radius fractures is vitamin D deficiency 6. Therefore, beginning from the premise that adequate vitamin D levels are essential for good bone health, researchers have investigated whether vitamin D deficiency might be why deficient subjects, who would clearly be more prone to fragility fractures, are more likely to be affected by CRPS.
Another aspect under investigation is whether vitamin D deficiency can, in the presence of a fracture event and independently of other variables, favour the onset of CRPS. Distal radius fracture (Colles' fracture) has been the most extensively investigated fracture event. In a retrospective orthopaedic study in 2020 of more than 100 postmenopausal women, those who experienced the onset of CRPS after a distal radius fracture had significantly lower levels of plasma vitamin D than those without CRPS (Fig. 1) 7. It is compelling to point out that biochemical markers for bone turnover (i.e., osteocalcin and alkaline phosphatase), as well as bone density assessments carried out on both the lumbar . . . . .
 Download the PDF from VitaminDWiki

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Comparing the Effects of Vitamins C and D in Preventing Complex Regional Pain Syndrome After Distal Radius Fracture Treatment - 2022

JROS 2022; 9 (3) :157-164 10.32598/JROSJ.9.3.987.2
Adel Ebrahimpour1 , Farsad Biglari1 , Amir Sabaghzadeh1 , Saber Barazandeh Rad1 , Mehrdad Sadighi1 , Tohid Moradian1 , Meisam Jafari Kafiabadi 1
1- Department of Orthopedic Surgery, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: The inflammatory response following trauma is the possible pathophysiology of complex regional pain syndrome (CRPS) I, caused by the release of pro-inflammatory factors and neuropeptides. Vitamins C and D are two antioxidants that can effectively prevent the occurrence of CRPS I.
Objectives: The primary aim of this study was to compare the effectiveness of vitamins C and D in preventing the occurrence of CRPS following the fixation of distal radius fractures.
Methods: The study was performed from January 1, 2018 to the end of December 2019. Patients who had fractured distal radius were candidates for external fixation and PCP. The patients were divided into three groups: 1) Receiving 500 mg of vitamin C daily for 50 days, 2) Receiving an oral dose of vitamin D of 5000 IU weekly for 50 days, and 3) Receiving no complementary medicine (control group).
Results: Of the 150 fractures, 62 type C3, 56 type C2, and 32 type C1 were observed, constituting 41.3%, 37.3%, and 21.3% of the total. During the two follow-up sessions, CRPS occurred in 28 patients (18.7%). Among the 28 patients mentioned, 14 patients (50%) belonged to group C, 8 patients (28.6%) belonged to group B, and 6 patients (21.4%) belonged to group A.
Conclusion: The use of vitamins C and D reduced the incidence of CRPS in patients with distal radius fractures. Also, the use of these vitamins was significantly effective in improving CRPS and reducing pain and ROM limitation.

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Effect of Perioperative Vitamin C on the Incidence of Complex Regional Pain Syndrome: A Systematic Review and Meta-Analysis - Aug 2022

The Journal of Foot and Ankle Surgery Volume 61, Issue 4, July–August 2022, Pages 748-754
https://doi.org/10.1053/j.jfas.2021.11.008 PDF behind paywall

Complex regional pain syndrome type 1 (CRPS-I) is a complex complication that occurs after limb extremity surgeries. Controversy exists regarding the effectiveness of vitamin C in reducing that condition. Therefore, we conducted this systematic review and meta-analysis to assess the role of vitamin C on CRPS-I and functional outcomes after distal radius, wrist, foot, and ankle surgeries. We searched Medline (via PubMed), Embase, the Cochrane Library, Clinicaltrial.gov, and Google Scholar for relevant studies comparing perioperative vitamin C versus placebo after distal radius, wrist, foot, and ankle surgeries from infinity to May 2021. Continuous data such as functional outcomes and pain scores were pooled as mean differences, while dichotomous variables such as the incidence of complex regional pain syndrome and complications were pooled as odds ratios, with 95% confidence interval, using R software (meta package, version 4.9-0) for Windows. Eight studies were included. The timeframe for vitamin C administration in each study ranged from 42 to 50 days postinjury and/or surgical fixation. The effect size showed that vitamin C was associated with a decreased rate of CRPS-1 than placebo (odds ratio 0.33, 95% confidence interval [0.17, 0.63]). No significant difference was found between vitamin C and placebo in terms of complications (odds ratio 1.90, 95% confidence interval [0.99, 3.65]), functional outcomes (mean difference 6.37, 95% confidence interval [-1.40, 14.15]), and pain scores (mean difference -0.14, 95% confidence interval [-1.07, 0.79]). Overall, vitamin C was associated with a decreased rate of CRPS-I than placebo, while no significant difference was found regarding complications, functional outcomes, and pain scores. These results hold true when stratifying fracture type (distal radius, ankle, and foot surgeries) and vitamin C dose (500 mg or 1 g).

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What is Complex Regional Pain Syndrome - asked Perplexity AI Jan 2025

Complex Regional Pain Syndrome (CRPS) is a chronic neurological condition that causes severe, persistent pain, typically affecting one limb - usually an arm, leg, hand, or foot  1  4
 The pain experienced is disproportionately intense compared to the initial injury or trigger that may have caused it  2
Key Characteristics
Pain Symptoms
The primary symptom is severe burning or throbbing pain that is much more intense than would be expected from the triggering injury. The affected area becomes extremely sensitive, where even light touches or temperature changes can cause intense pain  1  10
Physical Changes
The condition causes dramatic changes in the affected limb, including:

• Skin temperature fluctuations between hot and cold
• Skin color variations (white, red, purple, or mottled)
• Swelling and joint stiffness
• Changes in hair and nail growth
• Excessive sweating  1

Disease Progression
Stage 1 (Acute)
Lasting 1-3 months, this initial stage features severe burning pain, skin temperature changes, rapid hair and nail growth, and increased sweating  1  3
Stage 2 (Dystrophic)
Occurring between 3-6 months, symptoms worsen with increased pain levels, brittle nails, and muscle weakening  1
Stage 3
If untreated, the condition can lead to permanent changes, including muscle atrophy and contractures in the affected limb  1
Treatment Approach
While there is no cure for CRPS, early treatment is crucial for better outcomes  1
 Treatment typically involves:
Non-invasive Methods

• Physical and occupational therapy
• Pain medications and anti-inflammatory drugs
• Psychological support  1

Invasive Treatments

• Nerve blocks
• Spinal cord stimulation
• Surgery in severe cases  1

The condition requires a comprehensive treatment approach, with physical therapy being one of the most important components for managing symptoms and preventing progression  8

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What is the incidence of Complex Regional Pain Syndrome - asked Perplexity AI Jan 2025

The incidence of Complex Regional Pain Syndrome (CRPS) varies across studies, but recent epidemiological data provides clear insights into its frequency and distribution.
General Population Incidence
The overall incidence of CRPS ranges from 5.5 to 26.2 cases per 100,000 person-years  2  3  4
 The significant variation in reported rates is largely due to differences in diagnostic criteria used across studies.
Demographics and Risk Factors

• Women are affected 3-4 times more frequently than men  1  4
• Peak age of onset occurs between 50-70 years  1
• Highest incidence is found in females aged 61-70 years  4
• Postmenopausal women appear to have the highest risk  4

Injury-Related Incidence
Post-Fracture Cases

• 3-7% of patients develop CRPS after fractures in recent studies  1
• Following distal radius fracture, approximately 2 in 1,000 patients develop CRPS  2
• After ankle fracture, the incidence is about 15.2%  3

Post-Surgery Cases

• Shoulder surgery: 0.9-11.1% of cases
• Carpal tunnel release: 1.9-5.0%
• Ankle and foot surgery: 4.4%  3

Anatomical Distribution

• Upper extremities are more commonly affected than lower extremities  2
• Hand and wrist account for 67.3% of cases
• Foot and ankle represent 22.6% of cases  2

The condition affects approximately 200,000 patients annually in the United States  9

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Complex Regional Pain Syndrome (Excellent - 2024?)

Ross Hauser, MD

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VitaminDWiki – Falls and Fractures category contains

• 259 items in FALLS and FRACTURES
• Vitamin D and Calcium cost-effectively reduce falls and fractures – April 2019
• see also Overview Seniors and Vitamin D
  • Overview Fractures and Falls and Vitamin D
  • Overview Fractures and vitamin D
  • Muscles and Vitamin D - many studies

Falls

• Fall prevention - Vitamin D is one of the ways - umbrella review Jan 2024
• Deaths due to falls doubled in just a decade (age-adjusted, perhaps decreased vitamin D) – June 2019
• Preventing Falls in Older Adults – Vitamin D combination is the best - JAMA Meta-analysis Nov 2017
• Falls cut in half by 100,000 IU vitamin D monthly - RCT 2016
• Falls reduced by a third if achieved 40 ng level vitamin D– RCT Sept 2018
  • Note: It took 6 months to get to that level. Most trials last only 3 months
• Vitamin D prevents falls – majority of meta-analyses conclude – meta-meta analysis Feb 2015
• Falls reduced by Vitamin D: 13 percent reduction if more than 700 IU – review of 38 trials – Aug 2022

Left hand column section as of Nov 2024

Fracture

• Hip fractures are predicted by 10 factors – low Vitamin D is the biggest – Aug 2023
• Vitamin D and fractures – 24 meta-analyses and counting – Dec 2014
• Low trauma bone fractures in seniors – considering Vitamin D loading dose for all, without testing – Nov 2019
• Vitamin K (any amount and any kind) reduced bone fractures by 24 percent – meta-analysis – May 2019
• 77+ Hip fracture items in VitaminDWiki title   Click here for details examples:
  • Risk of Hip fracture cut in half if Vitamin D was prescribed - Aug 2023
  • Call to action: Vitamin D to prevent of treat hip fracture (50,000 weekly for 8 weeks, then bi-weekly) – Holick July 2020