{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T05:08:41Z","timestamp":1784610521100,"version":"3.55.0"},"reference-count":30,"publisher":"BMJ","issue":"5","funder":[{"DOI":"10.13039\/100017051","name":"College of Medicine, Seoul National University","doi-asserted-by":"publisher","award":["800-2021-0551"],"award-info":[{"award-number":["800-2021-0551"]}],"id":[{"id":"10.13039\/100017051","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2024,12,24]]},"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Despite the significant role of impaired bone metabolism in complex regional pain syndrome (CRPS), the clinical implications of osteopenia remain a focal point of investigation. We examined the prevalence and risk factors of affected limb osteopenia in CRPS and its association with the response to sympathetic blockade.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>167 patients with CRPS who underwent CT of their affected limbs were retrospectively reviewed. After conducting univariable analyses where regional osteopenia determined by CT was dependent and other clinical factors were independent variables, the first multivariable analysis assessed risk predictors associated with regional osteopenia in CRPS. Next, after conducting univariable analyses where sympathetic block response was dependent and others, including regional osteopenia, were independent variables, the second multivariable model predicted factors associated with the response to sympathetic blockades, followed by receiver operating characteristic curve analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 116 patients, regional osteopenia was identified in 72.2% early (&lt;1 year) and 52.5% persistent CRPS. In the first multivariable analysis adjusted for age, sex, body mass index (BMI), and other variables with p values&lt;0.1 from initial univariable analyses, older age (OR 1.06; 95%\u2009CI 1.02 to 1.10) and positive three-phase bone scintigraphy (TPBS) (OR 3.94; 95%\u2009CI 1.46 to 10.66) were significantly associated with regional osteopenia. In the second multivariable model adjusted for age, sex, BMI, and other variables with p values&lt;0.1 from univariable analyses, early phase (OR 5.49; 95%\u2009CI 1.44 to 20.88), regional osteopenia (OR 5.11; 95%\u2009CI 1.49 to 17.53), and positive TPBS (OR 6.30; 95%\u2009CI 2.21 to 17.93) were significantly associated with positive responses to sympathetic blockade in CRPS, showing excellent performance characteristics with a predicted probability&gt;0.358 (sensitivity 0.86; specificity 0.76).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Regional osteopenia in the affected limb can anticipate positive responses to sympathetic blockade when combined with TPBS in early CRPS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/rapm-2024-106111","type":"journal-article","created":{"date-parts":[[2025,2,17]],"date-time":"2025-02-17T18:05:23Z","timestamp":1739815523000},"page":"547-553","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Clinical implication of regional osteopenia in complex regional pain syndrome: a retrospective comparative study"],"prefix":"10.1136","volume":"51","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8784-7356","authenticated-orcid":false,"given":"Jeongsoo","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Jongno-gu, Korea (the Republic of)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyungsang","family":"Rho","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Jongno-gu, Korea (the Republic of)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongjae","family":"Yoo","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Jongno-gu, Korea (the Republic of)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joon","family":"Cha","sequence":"additional","affiliation":[{"name":"University of South Florida Morsani College of Medicine, Tampa, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunghoon","family":"Park","sequence":"additional","affiliation":[{"name":"Seoul National University College of Medicine, Jongno-gu, Korea (the Republic of)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hangaram","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Jongno-gu, Korea (the Republic of)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanihah Che","family":"Omar","sequence":"additional","affiliation":[{"name":"Universiti Sains Malaysia - Kampus Kesihatan, Kubang Kerian, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5551-7750","authenticated-orcid":false,"given":"Jee Youn","family":"Moon","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Jongno-gu, Korea (the Republic of)"},{"name":"Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea (the Republic of)"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,2,17]]},"reference":[{"key":"2026050502150677000_51.5.547.1","doi-asserted-by":"crossref","first-page":"e424","DOI":"10.1016\/j.bja.2019.03.030","article-title":"Complex regional pain syndrome: a narrative review for the practising clinician","volume":"123","author":"Shim","year":"2019","journal-title":"Br J Anaesth"},{"key":"2026050502150677000_51.5.547.2","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1016\/S1474-4422(24)00076-0","article-title":"Complex regional pain syndrome: advances in epidemiology, pathophysiology, diagnosis, and treatment","volume":"23","author":"Ferraro","year":"2024","journal-title":"Lancet Neurol"},{"key":"2026050502150677000_51.5.547.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.pain.2010.04.030"},{"key":"2026050502150677000_51.5.547.4","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000002245"},{"key":"2026050502150677000_51.5.547.5","doi-asserted-by":"crossref","first-page":"794","DOI":"10.1002\/ejp.2116","article-title":"The role of the bone in complex regional pain syndrome 1-A systematic review","volume":"27","author":"Kollmann","year":"2023","journal-title":"Eur J Pain"},{"key":"2026050502150677000_51.5.547.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.pain.2014.01.014"},{"key":"2026050502150677000_51.5.547.7","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1007\/s00774-018-0976-2","article-title":"Bone microstructure is significantly altered in CRPS-affected distal tibiae as detected by HR-pQCT: a retrospective cross-sectional study","volume":"37","author":"Oehler","year":"2019","journal-title":"J Bone Miner Metab"},{"key":"2026050502150677000_51.5.547.8","doi-asserted-by":"crossref","first-page":"1261","DOI":"10.1097\/j.pain.0000000000001520","article-title":"Compared to limb pain of other origin, ultrasonographic osteodensitometry reveals loss of bone density in complex regional pain syndrome","volume":"160","author":"Bazika-Gerasch","year":"2019","journal-title":"Pain"},{"key":"2026050502150677000_51.5.547.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.bone.2009.11.034"},{"key":"2026050502150677000_51.5.547.10","doi-asserted-by":"publisher","DOI":"10.1097\/AJP.0b013e3181c20207"},{"key":"2026050502150677000_51.5.547.11","doi-asserted-by":"publisher","DOI":"10.1097\/01.bor.0000231913.32364.32"},{"key":"2026050502150677000_51.5.547.12","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0b013e31823da45f"},{"key":"2026050502150677000_51.5.547.13","doi-asserted-by":"crossref","first-page":"216","DOI":"10.3344\/kjp.22299","article-title":"A comparison of analgesic efficacy and safety of clonidine and methylprednisolone as additives to 0.25% ropivacaine in stellate ganglion block for the treatment of complex regional pain syndrome: a prospective randomised single blind study","volume":"36","author":"Naskar","year":"2023","journal-title":"Korean J Pain"},{"key":"2026050502150677000_51.5.547.14","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1038\/nature03398","article-title":"Leptin regulation of bone resorption by the sympathetic nervous system and CART","volume":"434","author":"Elefteriou","year":"2005","journal-title":"Nature New Biol"},{"key":"2026050502150677000_51.5.547.15","doi-asserted-by":"publisher","DOI":"10.1084\/jem.20102608"},{"key":"2026050502150677000_51.5.547.16","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/j.bone.2018.03.025","article-title":"Inverse association between sympathetic nervous system activity and bone mass in middle aged overweight individuals","volume":"111","author":"Lambert","year":"2018","journal-title":"Bone"},{"key":"2026050502150677000_51.5.547.17","doi-asserted-by":"publisher","DOI":"10.1172\/JCI122151"},{"key":"2026050502150677000_51.5.547.18","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)61602-X"},{"key":"2026050502150677000_51.5.547.19","unstructured":"Legal amendment of enforcement decree of the act on well fare of persons with disabilities. 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