SLR - June 2009 - Syamak Yamini
Reference:
M. de Mos, F.J.P.M. Huygen, B.H.Ch. Stricker, J.P. Dieleman, M.C.J.M. Sturkenboom (2009). The association between ACE inhibitors and the complex regional pain syndrome:Suggestions for a neuroinflammatory pathogenesis of CRPS. International Association for the study of pain, 142, 218-224.
Scientific Literature Reviews
Reviewed by: Syamak Yamini DPM; Charles Han DPM
Residency Program: DVA Greater Los Angeles Veteran Affairs/UCLA-Olive View Medical Center
Podiatric Relevance:
This study demonstrates that patients taking ACE inhibitors for hypertension could be at an increased risk for the development of complex regional pain syndrome (CRPS). Foot and ankle surgeons should be aware that ACE inhibitor use may be associated with CRPS onset.
Methods:
This was a retrospective study involving 883 patients utilizing a case-control design. The study compared antihypertensive drug use in patients with CRPS to control patients from the same general population. A total of 186 cases were matched to 697 controls. Cases were identified from electronic records between 1996-2005. Up to four controls per case were selected, matched on gender, age, calendar time, and injury. In this study, the mean age of the patients was 51 years and 77% were female. Exposure to ACE inhibitors, angiotensin II receptor antagonists, B-blockers, calcium channel blockers, and diuretics were assessed from the automated prescription records. Multivariate conditional logistic regression analyses were performed to study the association between current and past use of antihypertensive drugs and CRPS onset, calculating crude and adjusted odd ratios with 95% confidence intervals.
Results:
No significant associations were observed between CRPS and the use of beta blocker, angiotensin II receptor antagonist, calcium channel blocker or diuretics. The use of ACE inhibitor was associated with an increased risk of CRPS. There was also a higher association of CRPS with monotherapy use and in women. Additionally, there were also stronger association with long-term use and higher dose of ACE inhibitors and CRPS.
Conclusion:
The use ACE inhibitors had higher association with the development of CRPS, especially with higher
doses and long term use.