***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The microcirculation appears to be impaired in cold chronic complex regional pain syndrome ( CRPS ) . This double-blind , placebo-controlled , r and omized trial investigated the effect of the nitric oxide ( NO ) donor isosorbide dinitrate ( ISDN ) on the peripheral blood flow in patients with chronic CRPS . Twenty-four patients received 1 % ISDN in Vaseline or a placebo ointment applied to the dorsum of the affected h and four times daily for 10 weeks . The patients participated in a physical therapy program to improve activity . The primary outcome measure was blood distribution in the affected extremity , which was determined by measuring the skin temperature using videothermography . We also measured NO and endothelin-1 concentrations in blister fluid , pain using the visual analog scale , and activity limitations using an upper limb activity monitor and the Disabilities of Arm Shoulder and H and Question naire .  ISDN failed to produce a significant improvement in temperature asymmetry in chronic cold CRPS patients , and it did not result in the expected reduction in pain and increase in activity compared with placebo either . There may be other central or peripheral factors contributing to the disturbed vasodynamics in cold chronic CRPS that are not influenced by NO substitution . This study does not show an improvement of the regional blood distribution by ISDN  in the involved extremity of patients with cold-type CRPS Abstract Animal and human studies indicate that electrical stimulation of dorsal root ganglion ( DRG ) neurons may modulate neuropathic pain signals . ACCURATE , a pivotal , prospect i ve , multicenter , r and omized comparative effectiveness trial , was conducted in 152 subjects diagnosed with complex regional pain syndrome or causalgia in the lower extremities . Subjects received neurostimulation of the DRG or dorsal column ( spinal cord stimulation , SCS ) . The primary end point was a composite of safety and efficacy at 3 months , and subjects were assessed through 12 months for long-term outcomes and adverse events . The predefined primary composite end point of treatment success was met for subjects with a permanent implant who reported 50 % or greater decrease in visual analog scale score from preimplant baseline and who did not report any stimulation-related neurological deficits . No subjects reported stimulation-related neurological deficits . The percentage of subjects receiving ≥50 % pain relief and treatment success was greater in the DRG arm ( 81.2 % ) than in the SCS arm ( 55.7 % , P < 0.001 ) at 3 months . Device-related and serious adverse events were not different between the 2 groups . Dorsal root ganglion stimulation also demonstrated greater improvements in quality of life and psychological disposition . Finally , subjects using DRG stimulation reported less postural variation in paresthesia ( P < 0.001 ) and reduced extraneous stimulation in nonpainful areas ( P = 0.014 ) , indicating DRG stimulation provided more targeted therapy to painful parts of the lower extremities . As the largest prospect i ve , r and omized comparative effectiveness trial to date , the results show that DRG stimulation provided a higher rate of treatment success with less postural variation in paresthesia intensity compared to SCS OBJECTIVES Complex regional pain syndrome ( CRPS ) , formerly known as reflex sympathetic dystrophy ( RSD ) , is a painful , disabling disorder for which treatment is difficult . The aim of this study was to determine the efficacy of pamidronate in a double-blind r and omized placebo-controlled trial . METHODS Patients referred to our regional multidisciplinary pain management center who fulfilled the International Association for the Study of Pain criteria for CRPS Type I were enrolled in the study over a 2-year period . Patients were administered , intravenously , either pamidronate , 60 mg as a single dose , or normal saline . Patients ' pain scores , global assessment of disease severity scores , and functional assessment ( SF-36 ) scores were documented at baseline and at 1 and 3 months . RESULTS Twenty-seven patients ( 18 female , 9 male ; average age 45 years ) were recruited , of whom 14 received pamidronate and 13 received placebo . Overall improvements in pain score , patient 's global assessment of disease severity score , and physical function ( SF-36 ) score were noted in the pamidronate group at 3 months , and improvements in role physical ( SF-36 ) score were noted at 1 and 3 months . There was variability in pamidronate response among individuals . CONCLUSIONS Pamidronate may be a useful treatment option in the management of patients with CRPS Type I. Although treatment response was variable , the majority of patients improved . Early administration in t and em with other treatment measures is recommended Chronic reflex sympathetic dystrophy is a painful , disabling disorder for which no treatment with proven effect is available . We performed a r and omized trial in a 2 to 1 ratio of patients , in which 36 patients were treated with spinal cord stimulation and physical therapy ( SCS+PT ) , and 18 patients received solely PT . Twenty‐four SCS+PT patients were given a permanent spinal cord stimulation system after successful test stimulation ; the remaining 12 patients received no permanent system . We assessed pain intensity , global perceived effect , functional status , and health‐related quality of life . Patients were examined before r and omization , before implantation , and also at 1 , 3 , 6 , 12 , and 24 months thereafter . At 2 years , three patients were excluded from the analysis . The intention‐to‐treat analysis showed improvements in the SCS+PT group concerning pain intensity ( −2.1 vs 0.0 cm ; p < 0.001 ) and global perceived effect ( 43 % vs 6 % “ much improved ” ; p = 0.001 ) . There was no clinical ly important improvement of functional status . Health‐related quality of life improved only in the group receiving spinal cord stimulation . After careful selection and successful test stimulation , spinal cord stimulation results in a long‐term pain reduction and health‐related quality of life improvement in chronic reflex sympathetic dystrophy & NA ; Complex regional pain syndrome type 1 ( CRPS1 ) involves cortical abnormalities similar to those observed in phantom pain and after stroke . In those groups , treatment is aim ed at activation of cortical networks that subserve the affected limb , for example mirror therapy . However , mirror therapy is not effective for chronic CRPS1 , possibly because movement of the limb evokes intolerable pain . It was hypothesised that preceding mirror therapy with activation of cortical networks without limb movement would reduce pain and swelling in patients with chronic CRPS1 . Thirteen chronic CRPS1 patients were r and omly allocated to a motor imagery program ( MIP ) or to ongoing management . The MIP consisted of two weeks each of a h and laterality recognition task , imagined h and movements and mirror therapy . After 12 weeks , the control group was crossed‐over to MIP . There was a main effect of treatment group ( F(1,11)=57 , P<0.01 ) and an effect size of ∼25 points on the Neuropathic pain scale . The number needed to treat for a 50 % reduction in NPS score was ∼2 . The effect of treatment was replicated in the crossed‐over control subjects . The results uphold the hypothesis that a MIP initially not involving limb movement is effective for CRPS1 and support the involvement of cortical abnormalities in the development of this disorder . Although the mechanisms of effect of the MIP are not clear , possible explanations are sequential activation of cortical pre‐motor and motor networks , or sustained and focussed attention on the affected limb , or both OBJECTIVES To explore the feasibility of intravenous magnesium administration as a potential c and i date intervention for a large size trial in Complex Regional Pain Syndrome Type 1 ( CRPS 1 ) . DESIGN R and omized clinical trial . SETTING Outpatient pain clinic . PATIENTS Ten CRPS 1 patients . INTERVENTIONS Eight patients received 70 mg/kg magnesium sulphate infusions in 4 hours for 5 days . For blinding purpose s , 2 patients received equal amount NaCl 0.9 % solutions ( data not analyzed or presented ) . Interventions were accompanied by st and ardized physical therapy . OUTCOME MEASURES Pain was assessed using an 11-point Box scale ( three times daily for a week ) and the McGill Pain Question naire . Skin sensitivity was measured with the Semmes Weinstein Monofilaments , ( other ) impairments with the Impairment Level Sumscore . In addition , functional limitations ( Radboud Skills Question naire , question naire rising and sitting down ) and quality of life ( Short Form-36 [ SF-36 ] , EuroQol ) were evaluated . Assessment s were performed at baseline , 1 , 3 , 6 , and 12 weeks after intervention . RESULTS Mild systemic side effects were experienced and the infusions were locally well tolerated . Pain was significantly reduced at all follow up compared with baseline ( T1 : P = 0.01 , T3 : P = 0.04 , T6 : P = 0.02 , T12 : P = 0.02 ) . McGill sensory subscale improved significantly at T1 ( number of words chosen : P = 0.03 and pain rating index : P = 0.03 ) . Impairment level ( P = 0.03 ) and quality of life ( EuroQol P = 0.04 , SF-36 physical P = 0.01 ) were significantly improved at T12 . No improvement was found for skin sensitivity and functional limitations . CONCLUSION Intravenous magnesium significantly improved pain , impairment and quality of life and was well tolerated . The results of this pilot study are encouraging and suggest that magnesium IV as a treatment in CRPS 1 should be further explored in a large size formal trial design & NA ; In complex regional pain syndrome ( CRPS1 ) initiated by wrist fracture , a motor imagery program ( MIP ) , consisting of h and laterality recognition followed by imagined movements and then mirror movements , reduces pain and disability , but the mechanism of effect is unclear . Possibilities include sustained attention to the affected limb , in which case the order of MIP components would not alter the effect , and sequential activation of cortical motor networks , in which case it would . Twenty subjects with chronic CRPS1 initiated by wrist fracture and who satisfied stringent inclusion criteria , were r and omly allocated to one of three groups : h and laterality recognition , imagined movements , mirror movements ( RecImMir , MIP ) ; imagined movements , recognition , imagined movements ( ImRecIm ) ; recognition , mirror movements , recognition ( RecMirRec ) . At 6 and 18 weeks , reduced pain and disability were greater for the RecImMir group than for the other groups ( P<0.05 ) . H and laterality recognition imparted a consistent reduction in pain and disability across groups , however , this effect was limited in magnitude . Imagined movements imparted a further reduction in pain and disability , but only if they followed h and laterality recognition . Mirror movements also imparted a reduction in pain and disability , but only when they followed imagined movements . The effect of the MIP seems to be dependent on the order of components , which suggests that it is not due to sustained attention to the affected limb , but is consistent with sequential activation of cortical motor networks Background . Complex regional pain syndrome type 1 ( CRPSt1 ) of the upper limb is a painful and debilitating condition , frequent after stroke , and interferes with the rehabilitative process and outcome . However , treatments used for CRPSt1 of the upper limb are limited . Objective . This r and omized controlled study was conducted to compare the effectiveness on pain and upper limb function of mirror therapy on CRPSt1 of upper limb in patients with acute stroke . Methods . Of 208 patients with first episode of unilateral stroke admitted to the authors ’ rehabilitation center , 48 patients with CRPSt1 of the affected upper limb were enrolled in a r and omized controlled study , with a 6-month follow-up , and assigned to either a mirror therapy group or placebo control group . The primary end points were a reduction in the visual analogue scale score of pain at rest , on movement , and brush-induced tactile allodynia . The secondary end points were improvement in motor function as assessed by the Wolf Motor Function Test and Motor Activity Log . Results . The mean scores of both the primary and secondary end points significantly improved in the mirror group ( P < .001 ) . No statistically significant improvement was observed in any of the control group values ( P > .001 ) . Moreover , statistically significant differences after treatment ( P < .001 ) and at the 6-month follow-up were found between the 2 groups . Conclusions . The results indicate that mirror therapy effectively reduces pain and enhances upper limb motor function in stroke patients with upper limb CRPSt1 Objective To compare the effectiveness of pain exposure physical therapy ( PEPT ) with conventional treatment in patients with complex regional pain syndrome type 1 ( CRPS-1 ) in a r and omised controlled trial with a blinded assessor . Setting The study was conducted at a level 1 trauma centre in the Netherl and s. Participants 56 adult patients with CRPS-1 participated . Three patients were lost to follow-up . Interventions Patients received either PEPT in a maximum of five treatment sessions , or conventional treatment following the Dutch multidisciplinary guideline . Measurements Outcomes were assessed at baseline and at 3 , 6 and 9 months after r and omisation . The primary outcome measure was the Impairment level Sum Score — Restricted Version ( ISS-RV ) , consisting of visual analogue scale for pain ( VAS-pain ) , McGill Pain Question naire , active range of motion ( AROM ) and skin temperature . Secondary outcome measures included Pain Disability Index ( PDI ) ; muscle strength ; Short Form 36 ( SF-36 ) ; disability of arm , shoulder and h and ; Lower Limb Tasks Question naire ( LLTQ ) ; 10 m walk test ; timed up- and -go test ( TUG ) and EuroQol-5D . Results The intention-to-treat analysis showed a clinical ly relevant decrease in ISS-RV ( 6.7 points for PEPT and 6.2 points for conventional treatment ) , but the between-group difference was not significant ( 0.96 
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Published trials continue to support the use of bisphosphonates and short courses of oral steroids in the setting of CRPS .
Similarly , trials also suggest an exp and ing role for peripheral sympathetic blockade ( i.e. , lumbar/thoracic sympathetic , stellate ganglion , and brachial plexus blocks ) .
Les essais suggèrent également un plus gr and rôle pour le bloc sympathique périphérique ( c’est-à-dire , blocs sympathiques lombaires/thoraciques , bloc du ganglion cervico-thoracique et du plexus brachial ) .