[Treatment of algodystrophies. The point of view of an anesthetist].
Algodystrophy is a complex and heterogenous syndrome, better defined as a subtype of Reflex Sympathetic Dystrophy syndrome (RSD). The pathophysiological theory of RSD has been supported by basic studies and clinical efficacy of sympathetic blocks. Results may be good, but some of RSD are not responsive to sympathetic blocks, and distinction between sympathetic dependent and independent pain has been proposed as subtypes of RSD. Physiotherapy is an essential part of RSD treatment. Sympathetic blocks and other analgesic therapies are performed in order to permit painless action of the physiotherapy against sick limbs stiffness. The rule must be: no painful physiotherapy. Use of other kind of drugs has yet to be defined. Calcitonin is potentially beneficial, but must be given in combination with blocks. Some new treatments rise interesting fundamental questions and some of them are under evaluation. Psychological support is the third part of treatment of these chronic pain patients. Multidisciplinary organisation, as offered by pain centers, can help to understand this syndrome and to elaborate guidelines for diagnosis, treatment and research programs.
Estève
M
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Hôpital Ambroise-Paré, Boulogne.
D001340:Autonomic Nerve Block / Q000379:methods*; D006145:Guanethidine / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007275:Injections, Intravenous; D026741:Physical Therapy Modalities; D012019:Reflex Sympathetic Dystrophy / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*
D006145:Guanethidine
Traitement des algodystrophies. Le point de vue d'un anesthésiste.