Evidence based guidelines for complex regional pain syndrome type 1

被引:199
作者
Perez, Roberto S. [1 ,2 ]
Zollinger, Paul E. [3 ]
Dijkstra, Pieter U. [4 ]
Thomassen-Hilgersom, Ilona L. [5 ]
Zuurmond, Wouter W. [1 ]
Rosenbrand, Kitty C. J. [6 ]
Geertzen, Jan H. [4 ]
机构
[1] Vrije Univ Amsterdam, Med Ctr, Dept Anaesthesiol, Amsterdam, Netherlands
[2] EMGO Inst Hlth & Care Res, Amsterdam, Netherlands
[3] Rivierenland Hosp, Dept Orthopaed Surg, Tiel, Netherlands
[4] Univ Groningen, Univ Med Ctr Groningen, Ctr Rehabil, Groningen, Netherlands
[5] Dutch Assoc Posttraumat Dystrophy Patients, Nijmegen, Netherlands
[6] Dutch Inst Healthcare Improvement CBO, Utrecht, Netherlands
关键词
REFLEX SYMPATHETIC DYSTROPHY; SPINAL-CORD STIMULATION; SYNDROME TYPE-I; ADJUVANT PHYSICAL-THERAPY; GRADED MOTOR IMAGERY; DOUBLE-BLIND; INTRATHECAL BACLOFEN; COST-EFFECTIVENESS; NEUROPATHIC PAIN; OPEN-LABEL;
D O I
10.1186/1471-2377-10-20
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background: Treatment of complex regional pain syndrome type I (CRPS-I) is subject to discussion. The purpose of this study was to develop multidisciplinary guidelines for treatment of CRPS-I. Method: A multidisciplinary task force graded literature evaluating treatment effects for CRPS-I according to their strength of evidence, published between 1980 to June 2005. Treatment recommendations based on the literature findings were formulated and formally approved by all Dutch professional associations involved in CRPS-I treatment. Results: For pain treatment, the WHO analgesic ladder is advised with the exception of strong opioids. For neuropathic pain, anticonvulsants and tricyclic antidepressants may be considered. For inflammatory symptoms, free-radical scavengers (dimethylsulphoxide or acetylcysteine) are advised. To promote peripheral blood flow, vasodilatory medication may be considered. Percutaneous sympathetic blockades may be used to increase blood flow in case vasodilatory medication has insufficient effect. To decrease functional limitations, standardised physiotherapy and occupational therapy are advised. To prevent the occurrence of CRPS-I after wrist fractures, vitamin C is recommended. Adequate perioperative analgesia, limitation of operating time, limited use of tourniquet, and use of regional anaesthetic techniques are recommended for secondary prevention of CRPS-I. Conclusions: Based on the literature identified and the extent of evidence found for therapeutic interventions for CRPS-I, we conclude that further research is needed into each of the therapeutic modalities discussed in the guidelines.
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页数:14
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