title: Amputation for long-standing, therapy-resistant type-I complex regional pain syndrome.
abstract: BACKGROUND
  Some patients with long-standing, therapy-resistant type-I complex regional pain syndrome consider an amputation. There is a lack of evidence regarding the risk of recurrence of the pain syndrome and patient outcomes after amputation. The goal of the present study was to evaluate the impact of an amputation on pain, participation in daily life activities, and quality of life as well as the use of a prosthesis and the risk of recurrence of the pain syndrome in patients with long-standing, therapy-resistant type-I complex regional pain syndrome.
  
  
  METHODS
  From May 2000 to October 2008, twenty-two patients underwent an amputation of a nonfunctional limb at our institution because of long-standing, therapy-resistant type-I complex regional pain syndrome. Twenty-one of these patients were included in our study. The median age was forty-six years (interquartile range [IQR], thirty-seven to fifty-one years), the median duration of the complex regional pain syndrome was six years (IQR, two to ten years), and the median interval between the amputation and the study was five years (IQR, three to seven years). A semistructured interview was conducted, physical examination of the residual limb was performed, and the patients completed two questionnaires.
  
  
  RESULTS
  Twenty patients (95%) reported an improvement in their lives. Nineteen patients (90%) reported a reduction in pain, seventeen patients (81%) reported an improvement in mobility, and fourteen (67%) reported an improvement in sleep. Eighteen of the twenty-one patients stated that they would choose to undergo an amputation again under the same circumstances. Ten of the fifteen patients with a lower-limb amputation and one of the six with an upper-limb amputation regularly used a prosthesis. The type-I complex regional pain syndrome recurred in the residual limb of three patients (14%) and symptoms recurred in another limb in two patients (10%).
  
  
  CONCLUSIONS
  Amputation may positively contribute to the lives of patients with long-standing, therapy-resistant type-I complex regional pain syndrome. Patients were likely to use a prosthesis after a lower-limb amputation. The risk of recurrence of the type-I complex regional pain syndrome was 24%.
authors: Departments of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, PO Box 30001, 9700 RB Groningen, the Netherlands. krans.h@bethesda.nl
authors: Hilde K
authors: HK
authors: Krans-Schreuder
authors: Marlies I
authors: MI
authors: Bodde
authors: Ernst
authors: E
authors: Schrier
authors: Pieter U
authors: PU
authors: Dijkstra
authors: Jan A
authors: JA
authors: van den Dungen
authors: Wilfred F
authors: WF
authors: den Dunnen
authors: Jan H
authors: JH
authors: Geertzen
mesh_terms: D000328:Adult; D000671:Amputation, Surgical; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D007866:Leg / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011788:Quality of Life; D012008:Recurrence; D012019:Reflex Sympathetic Dystrophy / Q000209:etiology / Q000601:surgery*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome