[Treatment of posttraumatic dystrophy].
Reflex sympathetic dystrophy, posttraumatic dystrophy or complex regional pain syndrome is a particular type of chronic pain. Although the origin is unknown, some believe that wide-dynamic range neurons located in the dorsal horn of the spinal cord play an essential role. Others consider the role of psychogenic factors underestimated. Until now, controlled clinical trials mainly directed at modulation of the sympathetic system have not revealed clearly effective therapies. Tests with guanethidine, phenylephrine, phentolamine or lidocaine have essentially been negative. Use of low dose glucocorticoids, dimethylsulphoxide, biphosphonates and epidurally applied clonidine require confirmation in studies of larger size. There are indications that invasive electrical spinal cord stimulation may have some effect; randomized studies in patients with posttraumatic dystrophy are needed. So far, only application of physical therapy at an early stage has clearly shown effective pain relief and would also lead to cost reduction.
Vecht
C J
CJ
Medisch Centrum Haaglanden, afd. Neurologie, Den Haag. ch.vecht@wxs.nl
D006801:Humans; D059408:Pain Management; D026741:Physical Therapy Modalities; D016032:Randomized Controlled Trials as Topic; D012019:Reflex Sympathetic Dystrophy / Q000188:drug therapy / Q000628:therapy*; D013563:Sympathectomy, Chemical / Q000379:methods*; D004561:Transcutaneous Electric Nerve Stimulation / Q000379:methods*; D016896:Treatment Outcome