Anti tumor necrosis factor - alpha adalimumab for complex regional pain syndrome type 1 (CRPS-I): A case series

Elon Eisenberg, Ifat Sandler, Roi Treister, Erica Suzan, May Haddad

Research output: Contribution to journalArticlepeer-review


Background and aims: Evidence suggests tumor necrosis factor-alpha (TNF-α) mediates, at least in part, symptoms and signs in complex regional pain syndrome (CRPS). Here, we present a case series of patients with CRPS type 1, in whom the response to the anti-TNF-α adalimumab was assessed. Methods: Ten patients with CRPS type 1 were recruited. Assessments were performed before treatment, at 1 week, and 1, 3, and 6 months following 3 biweekly subcutaneous injections (40 mg/0.8 mL) adalimumab (Humira®) and included the followings: Pain intensity using a 0-10 cm visual analog scale; the Short Form of the McGill Pain Questionnaire; the Beck Depression Inventory; the SF-36 questionnaire and mechanical and thermal thresholds (Von frey hair and Thermal Sensory Analyzer, respectively). In addition to the description of individual patient responses, both intention to treat (ITT) and per-protocol (PP) analyses were performed for the entire group. Results: Three subgroups of patients were identified (3 patients in each): "nonresponders", "partial responders", and "robust responders" in whom improvement in almost all parameters was noted. Both the ITT and PP analyses demonstrated only a trend toward improvement in mechanical pain thresholds following treatment (ITT χ2 = 13.83, P = 0.008; PP χ2 = 10.29, P = 0.036). Conclusion: These results suggest adalimumab, and possibly other anti-TNF-α, can be potentially useful in some (although not in all) patients with CRPS type 1. These preliminary results along with the growing body of evidence which points to the involvement of TNF-α in the pathogenesis of CRPS justify further studies in this area.

Original languageEnglish
Pages (from-to)649-656
Number of pages8
JournalPain Practice
Issue number8
StatePublished - Nov 2013
Externally publishedYes


  • Adalimumab
  • Anti-inflammatory agents
  • CRPS
  • Complex regional pain syndromes
  • TNF-α
  • Tissue necrosis factor

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine


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