Interrupting the sympathetic outflow in causalgia and reflex sympathetic dystrophy

Schott, G D

doi:10.1136/bmj.316.7134.792

Cited by 57 publications

(40 citation statements)

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“…If left untreated, these impairments can lead to functional limitations and disability. The lack of understanding of the etiology of this syndrome has led to patient management that tends to be poorly defi ned and symptom- [11][12][13][14] • Sympathetic nerve blocks 13,[15][16][17] • Physical therapy 8,10,13,[17][18][19] • Acupuncture 14,20 • Sympathectomy 13 • Spinal cord stimulation with electrodes implanted in the epidural space 12,14,[21][22][23][24][25] • Transcutaneous electrical nerve stimulation 14,26,27 Interdisciplinary pain management, with an emphasis on functional restoration, is thought to be necessary for an optimal outcome in treatment of individuals with this syndrome 28 . There is widespread agreement that physical therapy is of the utmost importance and an essential part of the treatment approach for CRPS I 3,8,10,13,17,26,29 .…”

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Physical Therapy Management of Complex Regional Pain Syndrome I in a 14-Year-Old Patient Using Strain Counterstrain: A Case Report

Collins¹

2007

Journal of Manual & Manipulative Therapy

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This report describes the examination, intervention, and outcomes for a patient with Complex Regional Pain Syndrome I (CRPS I) treated with Strain Counterstrain (SCS). The patient was diagnosed with CRPS I following a Grade II ankle sprain. Treatment consisted of SCS once per week for six months with one additional session each week in Months 4 through 6 for strengthening, endurance, and gait training. A re-examination was performed monthly. A clinically signifi cant decrease of 2 points in overall pain as measured with a numeric pain rating scale (NPRS) occurred as of Month 2; a 2-point decrease in tenderness on 10 of 13 SCS tender points also measured with an NPRS was documented as early as Month 1. Throughout the treatment period, an increase in function was noted by way of patient report and objective tests and measures. Gait improved with regard to cadence, use of an assistive device, and weight-bearing status. Single limb stance on the involved leg increased from 0 (s) to 40 (s) over the course of treatment and ankle active range of motion as measured with a goniometer and muscle strength as measured with manual muscle tests both returned to normal values. CRPS I remains a poorly understood and diffi cult-to-treat chronic syndrome. By way of its proposed effects on the neuromuscular system and facilitated segments, SCS may be an additional effective treatment tool in the management of some patients diagnosed with CRPS I.

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confidence: 99%

Physical Therapy Management of Complex Regional Pain Syndrome I in a 14-Year-Old Patient Using Strain Counterstrain: A Case Report

Collins¹

2007

Journal of Manual & Manipulative Therapy

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“…They also had two cases in which the endoscopic approach had to be converted to open cervical sympathectomy because of adhesions and pleural thickening caused by repeated SGB, which obscured the sympathic chain [2]. A meta-analysis of 1,144 patients showed that the benefit of sympathetic blockade with local anesthetic was indistinguishable from that of placebo [16].…”

Section: Predictive Value Of Sympathetic Blockadementioning

confidence: 99%

“…Since the introduction of minimally invasive approaches, endoscopic thoracic sympathectomy (ETS) has gained popularity. Recent research [2,[14][15][16] questioned the need for a positive effect of stellate ganglion block (SGB) before proceeding to surgical sympathectomy [3,17,18], and proposed the introduction of ETS early in the couse of the disease.…”

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Endoscopic thoracic sympathectomy for posttraumatic complex regional pain syndrome

Demey

Nijs

Coosemans

et al. 2011

Eur J Trauma Emerg Surg

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“…Eine Hemmung des Sympathikus im Bereich der betroffenen Extremität ist seit vielen Jahren ein etabliertes Therapieverfahren beim CRPS, obwohl es keine ausreichend gesicherten kontrollierte größe-re Studien dazu gibt [72,119]. Daher ist das Konzept des sympathisch unterhaltenen Schmerzes nicht unumstritten [99,140].…”

Section: Interventionelle Therapiemaßnahmen Am Sympathischen Nervensyunclassified

Das komplexe regionale Schmerzsyndrom

et al. 2003

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Since the term "complex regional pain syndromes" (CRPS) was introduced based on a revised taxonomy for disorders previously called reflex sympathetic dystrophy and causalgia in 1995, much knowledge grew up on the understanding and therapy of the disease. This review gives an overview on the clinical characteristics, pathophysiology, diagnostic tools and therapeutic options in CRPS. It will especially focus on recent findings on the role of the sympathetic nervous system, the central nervous system and peripheral inflammatory processes as underlying mechanisms. Although there is no diagnostic gold standard, careful clinical evaluation and additional apparative test procedures are very helpful for the diagnosis. An early and interdisciplinary approach is the basis for an optimal and successful treatment.

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Interrupting the sympathetic outflow in causalgia and reflex sympathetic dystrophy

Cited by 57 publications

References 11 publications

Physical Therapy Management of Complex Regional Pain Syndrome I in a 14-Year-Old Patient Using Strain Counterstrain: A Case Report

Physical Therapy Management of Complex Regional Pain Syndrome I in a 14-Year-Old Patient Using Strain Counterstrain: A Case Report

Endoscopic thoracic sympathectomy for posttraumatic complex regional pain syndrome

Das komplexe regionale Schmerzsyndrom

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