Referral and treatment patterns for complex regional pain syndrome in the Netherlands.
BACKGROUND
Patients with complex regional pain syndrome (CRPS) are seen and treated by a variety of physicians. The present study aims to describe referral and treatment patterns for CRPS patients in the Netherlands.


METHODS
Patients, who were selected (1996-2005) from an electronic general practice (GP) database (Integrated Primary Care Information Project), were invited for study participation, involving diagnosis verification (International Association for the Study of Pain criteria) and assessment of referrals and treatment through information retrieved from GP journals, patients' questionnaires, pharmacy dispensing lists and specialist letters if available.


RESULTS
One hundred and two patients were included. Sixty-one percent had presented first at the GP, while 80% subsequently consulted one or more medical specialists, most frequently an anesthetist (55% of the cases) or a specialist in rehabilitation medicine (41%). Over 90% of the patients received oral or topical pharmacotherapy, 45% received intravenous therapy, 89% received non-invasive therapy (i.e. physiotherapy) and 18% received nerve blocks. Analgesics and free radical scavengers were administered early during CRPS, while vasodilating drugs and drugs against neuropathic pain (antidepressants and anti-epileptics) were administered later on. Pharmacotherapy was usually initiated by a medical specialist.


CONCLUSIONS
The Dutch treatment guidelines, issued in 2006, recommend free radical scavenger prescription (plus physiotherapy) as the initial treatment step for CRPS. Until 2005 only half of the patients received a scavenger within 3 months after disease onset, and the majority presents first at the GP, in particular GPs may be encouraged to initiate treatment with scavengers, while waiting for the results of further specialist consultation.
DE Mos
M
M
Department of Medical Informatics and Epidemiology & Biostatistics, Erasmus University Medical Center, Rottedam, The Netherlands. m.vrolijk-demos@erasmusmc.nl
Huygen
F J P M
FJ
VAN DER Hoeven-Borgman
M
M
Dieleman
J P
JP
Stricker
B H Ch
BH
Sturkenboom
M C J M
MC
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use; D002648:Child; D020918:Complex Regional Pain Syndromes / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D016208:Databases, Factual; D004363:Drug Utilization; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009407:Nerve Block; D009426:Netherlands / Q000453:epidemiology; D010594:Pharmacies / Q000706:statistics & numerical data; D026741:Physical Therapy Modalities; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D055815:Young Adult
D000700:Analgesics