title: 25. Ischemic pain in the extremities and Raynaud's phenomenon.
abstract: Two important groups of disorders result from an insufficient blood supply to the extremities: critical vascular disease and the Raynaud's phenomenon. The latter can be subdivided into a primary and a secondary type. Critical ischemic disease is often caused by arteriosclerosis due to hypertension or diabetes. Primary Raynaud's is idiopathic and will be diagnosed as such if underlying systemic pathology has been excluded. Secondary Raynaud's is often a manifestation of a systemic disease. It is essential to try to establish a diagnosis as soon as possible in order to influence the evolution of the disease. A sympathetic nerve block can be considered in patients with critical ischemic vascular disease after extensive conservative treatment, preferably in the context of a study (2B±). If this has insufficient effect, spinal cord stimulation can be considered in a selected patient group (2B±). In view of the degree of invasiveness and the costs involved, this treatment should preferably be applied in the context of a study and with the use of transcutaneous pO(2) measurements. In case of primary Raynaud's, life style changes are the first step. Sympathectomy can be considered as a treatment of Raynaud's phenomenon (2C+), but only after multidisciplinary evaluation of the patient and in close consultation with the patient's rheumatologist, vascular surgeon or internist.
authors: Department of Anesthesiology and Multidisciplinary Pain Centre, University Hospital Ghent, Ghent, Belgium.
authors: Jacques
authors: J
authors: Devulder
authors: Hans
authors: H
authors: van Suijlekom
authors: Robert
authors: R
authors: van Dongen
authors: Sudhir
authors: S
authors: Diwan
authors: Nagy
authors: N
authors: Mekhail
authors: Maarten
authors: M
authors: van Kleef
authors: Frank
authors: F
authors: Huygen
mesh_terms: D019274:Botulinum Toxins, Type A / Q000627:therapeutic use; D004599:Electric Stimulation Therapy; D006801:Humans; D007511:Ischemia / Q000150:complications*; D009465:Neuromuscular Agents / Q000627:therapeutic use; D010146:Pain / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D059408:Pain Management / Q000379:methods*; D011928:Raynaud Disease / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D013116:Spinal Cord
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A