Surgical treatment of complex regional pain syndrome type II with regional subcutaneous venous sympathectomy.
BACKGROUND
The effectiveness of a new surgical technique for the treatment of severe chronic pain stages was evaluated. For the last 140 years, the treatment of complex regional pain syndrome type II (CRPS II) has been an unsolved problem. Therapeutic approaches have included conventional pain medication, physical therapy, sympathetic blocks, transcutaneous or spinal cord stimulation, injections or infusion therapies, and sympathectomy. When used alone or in combination, these therapies often yield unfavorable results. The majority of physicians who treat patients with CRPS are convinced that a surgical treatment of the affected extremity only exacerbates the symptoms, especially its hallmark excruciating pain.


METHODS
Sixteen patients with a CRPS type II of the upper or lower limb were included in the study after ineffective pain therapy for more than 6 months. The most proximal region of pain associated with CRPS was localized, and 2% lidocaine was injected into that area. Once the sympathetic, deep, burning pain had been blocked, the subcutaneous veins in the previously determined area were surgically removed. A visual analog scale, the Nottingham Health Profile, and physical examinations were used to evaluate the outcome of the operation.


RESULTS
Twelve (75%) surgically treated patients showed significant improvement in limb function, the visual analog scale, and the Nottingham Health Profile.


CONCLUSIONS
These data and recent findings in animal models conclude that CRPS type II is maintained by a coupling of newly sprouted sympathetic and sensible fibers. These fibers can be resected with a regional subcutaneous venous sympathectomy.


METHODS
Therapeutic study, level III.
Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.
Wolfgang
W
Happak
Sabine
S
Sator-Katzenschlager
Lukas K
LK
Kriechbaumer
D000328:Adult; D000368:Aged; D002422:Causalgia / Q000175:diagnosis* / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D035002:Lower Extremity / Q000294:innervation / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods*; D011182:Postoperative Care / Q000379:methods; D011446:Prospective Studies; D012008:Recurrence; D012720:Severity of Illness Index; D013562:Sympathectomy / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D034941:Upper Extremity / Q000294:innervation / Q000503:physiopathology; D014680:Veins / Q000601:surgery