Non-Pharmacological Interventions for the Treatment of Raynaud’s phenomenon—A Systematic Review Non-Pharmacological Interventions for Raynaud’s phenomenon
Article Sidebar
Main Article Content
Abstract
Objective: The objective of this systematic review is to describe existing literature pertaining to the use of non-pharmacological interventions (NPIs) for the management of primary or secondary Raynaud’s Phenomenon (RP) compared to placebo.
Methods: The Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE were searched from their inception to the present for randomized controlled trials and clinical trials for studies assessing the therapeutic effects NPIs in primary or secondary RP. The studies were screened, and data were extracted by two reviewers. The major outcomes assessed included frequency (per week) and duration (minutes) of attacks and pain.
Results: We found 23 parallel or crossover RCTs, 5 of which were not discussed in this review. The categories of NPIs included acupuncture and other needling techniques (n=4), temperature biofeedback (n=4), lasers and electrotherapy (n=5), exercise therapy (n=2), gas therapy (n=1), therapeutic gloves (n=1), and ischemic preconditioning (n=1). Most studies demonstrated trends towards therapeutic benefit; however, there was substantial heterogeneity amongst the studies. Laser therapy had the most consistent evidence; 60% and 75% of the studies reported significant improvements in frequency of attacks per week and pain. Acupuncture therapies had minimal statistically significant benefits and the data for temperature biofeedback were inconsistent and of low quality. Exercise therapy is more recently being explored showing a marked therapeutic benefit for pain.
Conclusion: The evidence is limited and inconsistent; however, the studies demonstrated a trend towards therapeutic benefits, with laser and electrotherapy having the most consistent evidence. Further high-quality and multi-center RCTs are required.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
- Authors publishing in the UOJM retain copyright of their articles, including all the drafts and the final published version in the journal.
- While UOJM does not retain any rights to the articles submitted, by agreeing to publish in UOJM, authors are granting the journal right of first publication and distribution rights of their articles.
- Authors are free to submit their works to other publications, including journals, institutional repositories or books, with an acknowledgment of its initial publication in UOJM.
- Copies of UOJM are distributed both in print and online, and all materials will be publicly available online. The journal holds no legal responsibility as to how these materials will be used by the public.
- Please ensure that all authors, co-authors and investigators have read and agree to these terms.
- Works are licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
Herrick AL. Pathogenesis of Raynaud's phenomenon. Rheumatology (Oxford). May 2005;44(5):587-96. doi:10.1093/rheumatology/keh552
Wigley FM. Clinical practice. Raynaud's Phenomenon. N Engl J Med. Sep 26 2002;347(13):1001-8. doi:10.1056/NEJMcp013013
García-Carrasco M, Jiménez-Hernández M, Escárcega RO, et al. Treatment of Raynaud's phenomenon. Autoimmun Rev. Oct 2008;8(1):62-8. doi:10.1016/j.autrev.2008.07.002
Maundrell A, Proudman SM. Epidemiology of Raynaud’s Phenomenon. Springer New York; 2014:21-35.
Silman A, Holligan S, Brennan P, Maddison P. Prevalence of symptoms of Raynaud's phenomenon in general practice. British Medical Journal. 1990;301(6752):590-592. doi:10.1136/bmj.301.6752.590
Roustit M, Blaise S, Allanore Y, Carpentier PH, Caglayan E, Cracowski J-L. Phosphodiesterase-5 inhibitors for the treatment of secondary Raynaud's phenomenon: systematic review and meta-analysis of randomised trials. Annals of the rheumatic diseases. 2013;72(10):1696-1699. doi:10.1136/annrheumdis-2012-202836
Rirash F, Tingey PC, Harding SE, et al. Calcium channel blockers for primary and secondary Raynaud's phenomenon. Cochrane library. 2017;2017(12):CD000467-CD000467. doi:10.1002/14651858.CD000467.pub2
Herrick AL, van den Hoogen F, Gabrielli A, et al. Modified‐release sildenafil reduces Raynaud's phenomenon attack frequency in limited cutaneous systemic sclerosis. Arthritis and rheumatism. 2011;63(3):775-782. doi:10.1002/art.30195
Goundry B, Bell L, Langtree M, Moorthy A. Diagnosis and management of Raynaud’s phenomenon. BMJ. 2012;344(7843):66-42. doi:10.1136/bmj.e289
Fraenkel L. Raynaud’s phenomenon: Epidemiology and risk factors. Current rheumatology reports. 2002;4(2):123-128. doi:10.1007/s11926-002-0007-z
Appiah R, Hiller S, Caspary L, Alexande K, Creutzig A. Treatment of primary Raynaud's syndrome with traditional Chinese acupuncture. Journal of internal medicine. 1997;241(2):119-124. doi:10.1046/j.1365-2796.1997.91105000.x
Freedman RR, Ianni P, Wenig P. Behavioral treatment of Raynaud's phenomenon in scleroderma. Journal of behavioral medicine. 1984;7(4):343-353. doi:10.1007/BF00845268
Daniels J, Pauling JD, Eccelston C. Behaviour change interventions for the management of Raynaud's phenomenon: a systematic review protocol. BMJ open. 2017;7(8):e017039-e017039. doi:10.1136/bmjopen-2017-017039
Higgins J, Thomas J, Chandler J, et al. Cochrane Handbook for Systematic Reviews of Interventions version 6.2 (updated February 2021). Cochrane; 2021. www.training.cochrane.org/handbook.
Review Manager (RevMan) [Computer program]. Version 5.4, The Cochrane Collaboration, 2020. https://training.cochrane.org/online-learning/core-software-cochrane-reviews/revman/revman-non-cochrane-reviews
Junger M, Rosch G, Mohrle M, et al. Efficiency of acupuncture in acral circulatory disturbances. Wirkung der Akupunktur bei akralen Durchblutungsstorungen. Phlebol. 1996;25(4):139-143.
Guo M-h, Tu W-Z, Chen D-d, Sun J-y, Sui M. Therapeutic effects on systemic scleroderma of integrated therapy of Traditional Chinese Medicine with penicillamine. Journal of Clinical Dermatology. 2008;37(7):464-466.
Dąbek A, Domaniecki J, Czyżewski P, Bujar-Misztal M. Evaluation of selected therapeutic
methods in patients with primary
raynaud’s syndrome. Borgis- New Medicine. 2013:3-8.
Zhou J, Yang D, Zhou S-h, Wang J-p, Liu Y-s, Wang S-l. Clinical Efficacy and Safety of Bathing with Chinese Medicine Taohong Siwu Decoction (桃红四物汤) for Treatment of Diffuse Cutaneous Systemic Sclerosis: A Randomized Placebo-Controlled Trial. Chinese journal of integrative medicine. 2017;24(3):185-192. doi:10.1007/s11655-017-2954-2
Hirschl M, Katzenschlager R, Francesconi C, Kundi M. Low level laser therapy in primary Raynaud's phenomenon--results of a placebo controlled, double blind intervention study. Journal of rheumatology. 2004;31(12):2408-2412.
Neferu R, Vanderhoek L, Hewitt S, Nevskaya T, Pope JE. A randomized, single-blinded cross-over trial of ischemic preconditioning in Raynaud's phenomenon. Journal of scleroderma and related disorders. 2017;2(3):213-220. doi:10.5301/jsrd.5000253
Hirschl M, Katzenschlager R, Ammer K, Melnizky P, Rathkolb O, Kundi M. Double-blind, randomised, placebo controlled low level laser therapy study in patients with primary Raynaud's phenomenon. Vasa. May 2002;31(2):91-4. doi:10.1024/0301-1526.31.2.91
Sporbeck B, Mathiske-Schmidt K, Jahr S, et al. Effect of biofeedback and deep oscillation on Raynaud’s phenomenon secondary to systemic sclerosis: results of a controlled prospective randomized clinical trial. Rheumatology international. 2011;32(5):1469-1473. doi:10.1007/s00296-011-1882-2
Comparison of Sustained-Release Nifedipine and Temperature Biofeedback for Treatment of Primary Raynaud Phenomenon: Results From a Randomized Clinical Trial With 1-Year Follow-up. Archives of internal medicine (1960). 2000;160(8):1101-1108. doi:10.1001/archinte.160.8.1101
Mitropoulos A, Gumber A, Crank H, Akil M, Klonizakis M. The effects of upper and lower limb exercise on the microvascular reactivity in limited cutaneous systemic sclerosis patients. Arthritis research & therapy. 2018;20(1):112-112. doi:10.1186/s13075-018-1605-0
Schmidt J, Monnet P, Normand B, Fabry R. Microcirculatory and clinical effects of serial percutaneous application of carbon dioxide in primary and secondary Raynaud's phenomenon. Vasa. May 2005;34(2):93-100. doi:10.1024/0301-1526.34.2.93
al-Awami M, Schillinger M, Maca T, Pollanz S, Minar E. Low level laser therapy for treatment of primary and secondary Raynaud's phenomenon. Vasa. Feb 2004;33(1):25-9. doi:10.1024/0301-1526.33.1.25
Hahn M, Steins A, Möhrle M, Blum A, Jünger M. Is there a vasospasmolytic effect of acupuncture in patients with secondary Raynaud phenomenon? Journal der Deutschen Dermatologischen Gesellschaft. 2004;2(9):758-762. doi:10.1046/j.1439-0353.2004.04729.x
Gladue H, Berrocal V, Harris R, et al. A randomized controlled trial of acupressure for the treatment of Raynaud's phenomenon: the difficulty of conducting a trial in Raynaud's phenomenon. Journal of scleroderma and related disorders. 2016;1(2):226-233. doi:10.5301/jsrd.5000206
WANG S, Cai Yy, LU J-r. Warm Needling Therapy for Raynaudʾs Syndrome in30Cases. Shanghai Journal of Traditional Chinese Medicine. 2003;37(3):38-39.
Guglielmi RS, Roberts AH, Patterson R. Skin temperature biofeedback for Raynaud's disease: a double-blind study. Biofeedback and self-regulation. 1982;7(1):99-120. doi:10.1007/BF00999058
Büttner M, Henschel G, Spengel FA. [Effectiveness of temperature biofeedback in therapy of Raynaud's disease]. Vasa Suppl. 1991;32:411-5. Wirksamkeit von Temperatur-Biofeedback in der Therapie des Morbus Raynaud.
Kuryliszyn-Moskal A, Kita J, Dakowicz A, Klimiuk P, Kowal-Bielecka O. Assessment of the efficacy of laser biostimulation and low-frequency pulsed
magnetic field in the treatment of microvascular abnormalities in patients
with Raynaud’s phenomenon. Reumatologia. 2012;50(5):410-415.
Tapia-Haro RM, García-Ríos MC, Toledano-Moreno S, Casas-Barragán A, Castro-Sánchez AM, Aguilar-Ferrándiz ME. The complementary effects of galvanic current electrical stimulation associated with conservative treatment to increase vasodilation in patients with Raynaud’s phenomenon: a randomized trial. Clinical rehabilitation. 2020;34(5):595-606. doi:10.1177/0269215520907652
Mitropoulos A, Gumber A, Crank H, Akil M, Klonizakis M. Exploring the feasibility of an exercise programme including aerobic and resistance training in people with limited cutaneous systemic sclerosis. Clinical rheumatology. 2020;39(6):1889-1898. doi:10.1007/s10067-019-04921-7
Ko GD, Berbrayer D. Effect of ceramic-impregnated "thermoflow" gloves on patients with Raynaud's syndrome: randomized, placebo-controlled study. Alternative medicine review. 2002;7(4):328-335.
Malenfant D, Catton M, Pope JE. The efficacy of complementary and alternative medicine in the treatment of Raynaud's phenomenon: a literature review and meta-analysis. Rheumatology (Oxford, England). 2009;48(7):791-795. doi:10.1093/rheumatology/kep039
Visual Rx . Version 4. Dr. Christopher Cates EBM. http://www.nntonline.net
Schünemann H, Oxman A, Vist G, Higgins J, Deeks J, et al. Chapter 9: Analysing data and undertaking meta-analyses. In: Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011. The Cochrane Collaboration; 2011.
Higgins JPT, Deeks JJ, Altman DG on behalf of the Cochrane Statistical Methods Group (editors). Chapter 16: Special topics in statistics. In: Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011 . Available from handbook.cochrane.org.
Deeks JJ, Higgins JPT, Altman DG, editors. Chapter 9: Analysing data and undertaking meta-analyses. In: Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011 . Available from handbook.cochrane.org.
Egger M, Zellweger-Zähner T, Schneider M, Junker C, Lengeler C, Antes G. Language bias in randomised controlled trials published in English and German. The Lancet (British edition). 1997;350(9074):326-329. doi:10.1016/S0140-6736(97)02419-7
Sterne JAC, Sutton AJ, Ioannidis JPA, et al. Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. BMJ. 2011;343(7818):c4737-307. doi:10.1136/bmj.d4002
Higgins J, Altman D, Sterne J. Chapter 8: Assessing risk of bias in included studies. In: Higgins JPT, Green S (editors), Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration; 2011.
Higgins J, Green S. Cochrane handbook for systematic reviews of interventions. Cochrane book series. Wiley-Blackwell; 2008.