A very interesting and entirely coincidental finding was reported in Canada back in 2014. The case involved a young woman who had suffered (seemingly) therapy-resistant CRPS in her left upper limb for a period of 6 years. She had been treated with the full spectrum of medication including antispasmodics and opioids, as well as nerve root blocks, stellate ganglion blocks and extensive physiotherapy. Despite this, her condition had worsened and she had developed a claw hand.
However, after developing a minor infection under the fingernail on her left hand, she was prescribed a 10 day course of Cefadroxil, which is a broad spectrum antibiotic. Within days of commencing the course of Cefadroxil, she reported a reduction in her pain and allodynia, reduced clenching of her fingers and thumb, improved voluntary movement in her arm and a lessening of her fatigue.
Within 12 hours of completing the 10 day course, her symptoms reverted to their former level. Those treating her made a decision to carry out a short trial of alternating weeks on and off the Cefadroxil and monitored what happened. Within 2 to 3 days of recommencing the Cefadroxil, her pain and motor function again improved.
In terms of her pain alone, she reported that her daily average pain at rest whilst on Cefadroxil (where 0 = no pain and 10 = the worst imaginable pain) was 3.5 to 4, but quickly worsened to 8 when the Cefadroxil was withdrawn. After further discussion concerning the risks of long term exposure to antibiotics, a decision was made to continue the Cefadroxil.
When examined 3 years and 8 months after commencing Cefadroxil, she rated her pain at rest at 0, rising to 3 with prolonged use of her arm and hand and had near normal function of her left arm, although her forearm muscles remained atrophied. Her fingers were unclenched, but her hand was not fully functional. Nevertheless, this represented a substantial improvement in both pain and motor function.
In terms of the side effects of her continued intake of Cefadroxil, the young woman reported loose stools and serious difficulties getting to sleep, although she had begun self-medicating with cannabis before bedtime to help with that.
The authors of the study recommended a clinical trial to further investigate whether some antibiotics can benefit pain and motor function in CRPS. Their paper concludes with the following words:
“Given the severity of unrelieved pain that is often present in CRPS patients, we believe that even a low incidence of responders would be an important outcome.”
However, astonishingly, despite such promise, three years following publication of that paper, there is absolutely no indication of further research either already under way or intended in the future. In short, it’s all gone very quiet. We can only speculate on the reason.
With the next new superbug always around the corner, many fear that the war against bacterial infection may be all but lost. As we know, persuading our family doctor to prescribe antibiotics is now nigh on impossible; a rearguard action in the battle against antibiotic resistance. Medical procedures such as surgery and chemotherapy may become impossible if this battle is lost and we are again facing the possibility that in just a few years a chest infection or even a simple cut may prove life threatening.
With that in mind, should it be proven that some antibiotics are beneficial for CRPS, does this create a dilemma for licensing authorities? Further, is it possible that this more general concern regarding antibiotic resistance has resulted in pressure being brought to bear on researchers wishing to pursue this research further?
As for those with long standing, therapy-resistant CRPS, the search for an effective treatment continues.