ABSTRACT
OBJECTIVE: This is the fourth edition of diagnostic and treatment guidelines for complex regional pain syndrome (CRPS; aka reflex sympathetic dystrophy). METHODS: Expert practitioners in each discipline traditionally utilized in the treatment of CRPS systematically reviewed the available and relevant literature; due to the paucity of levels 1 and 2 studies, less rigorous, preliminary research reports were included. The literature review was supplemented with knowledge gained from extensive empirical clinical experience, particularly in areas where high-quality evidence to guide therapy is lacking. RESULTS: The research quality, clinical relevance, and "state of the art" of diagnostic criteria or treatment modalities are discussed, sometimes in considerable detail with an eye to the expert practitioner in each therapeutic area. Levels of evidence are mentioned when available, so that the practitioner can better assess and analyze the modality under discussion, and if desired, to personally consider the citations. Tables provide details on characteristics of studies in different subject domains described in the literature. CONCLUSIONS: In the humanitarian spirit of making the most of all current thinking in the area, balanced by a careful case-by-case analysis of the risk/cost vs benefit analysis, the authors offer these "practical" guidelines.
Subject(s)
Reflex Sympathetic Dystrophy/rehabilitation , Adrenergic alpha-Agonists/therapeutic use , Analgesics, Opioid/therapeutic use , Anesthetics, Local/therapeutic use , Anti-Inflammatory Agents/therapeutic use , Anticonvulsants/therapeutic use , Antidepressive Agents, Tricyclic/therapeutic use , Bone Density Conservation Agents/therapeutic use , Complex Regional Pain Syndromes/diagnosis , Complex Regional Pain Syndromes/drug therapy , Complex Regional Pain Syndromes/rehabilitation , Humans , Occupational Therapy , Physical Therapy Modalities , Receptors, N-Methyl-D-Aspartate/antagonists & inhibitors , Recreation Therapy , Reflex Sympathetic Dystrophy/diagnosis , Reflex Sympathetic Dystrophy/drug therapy , Rehabilitation, VocationalABSTRACT
In this review, the authors discuss the development of consensus-based treatment guidelines in 1997. They also synthesize the recommendations of a closed workshop held in Budapest in late 2004 that reexamined these treatment guidelines and made further and more detailed recommendations. They explore and develop the rationale for making functional restoration the pivotal treatment algorithm in the management of complex regional pain syndrome, around which all other treatments, such as psychotherapy, drugs, and interventions, revolve. The authors discuss in detail the process of functional restoration and the modalities appropriate to accomplishing that--specifically, the role of the occupational therapist, physical therapist, recreational therapist, and vocational rehabilitation specialist. Medications, interventions, and psychotherapy will be covered in other sections of this series.
