[Clinical practice guideline 'Complex regional pain syndrome type I'].
The development and treatment ofthe complex regional pain syndrome type I (CRPS-I) are a subject of much discussion. Using the method for the development ofevidence-based guidelines, a multidisciplinary guideline for the diagnosis and treatment of this syndrome has been drawn up. The diagnosis of CRPS-I is based on the clinical observation of signs and symptoms. For pain treatment, the WHO analgesic ladder is advised up to step z. In case of pain ofa neuropathic nature, anticonvulsants and tricyclic antidepressants may be considered. For the treatment ofinflammatory symptoms, free-radical scavengers (dimethylsulphoxide or acetylcysteine) are advised. In order to enhance peripheral blood flow, vasodilatory medication may be considered. Percutaneous sympathetic blockades may be used for a cold extremity ifvasodilatory medication produces insufficient effect. To decrease functional limitations, standardised physiotherapy and occupational therapy are advised. To prevent the occurrence of CRPS-I after wrist fractures, the use of vitamin C is recommended. Adequate perioperative analgesia, limitation of operation time and limited use of bloodlessness are advised for the secondary prevention of CRPS-I. Use of regional anaesthetic techniques can also be considered in this connection.
Perez
R S G M
RS
VU Medisch Centrum, afd. Anesthesiologie, Postbus 7057, 1007 MB Amsterdam. rsgm.perez@vumc.nl
Zollinger
P E
PE
Dijkstra
P U
PU
Thomassen-Hilgersom
I L
IL
Zuurmond
W W A
WW
Rosenbrand
C J G M
CJ
Geertzen
J H B
JH
D000111:Acetylcysteine / Q000627:therapeutic use; D002493:Central Nervous System Diseases / Q000503:physiopathology; D020918:Complex Regional Pain Syndromes / Q000175:diagnosis / Q000188:drug therapy*; D004121:Dimethyl Sulfoxide / Q000627:therapeutic use; D016166:Free Radical Scavengers / Q000627:therapeutic use; D006801:Humans; D009426:Netherlands; D017410:Practice Guidelines as Topic; D012039:Regional Blood Flow; D013564:Sympathetic Nervous System / Q000503:physiopathology; D014665:Vasodilator Agents / Q000627:therapeutic use
D016166:Free Radical Scavengers; D014665:Vasodilator Agents; D000111:Acetylcysteine; D004121:Dimethyl Sulfoxide