Current Pain and Headache Reports

, Volume 7, Issue 3, pp 188–196

Complex regional pain syndrome: A review of evidence-supported treatment options

  • E. Daniela Hord
  • Anne Louise Oaklander


Complex regional pain syndrome consists of pain and other symptoms that are unexpectedly severe or protracted after an injury. In type II complex regional pain syndrome, major nerve injury, often with motor involvement, is the cause; in complex regional pain syndrome I, the culprit is a more occult lesion, often a lesser injury that predominantly affects unmyelinated axons. In florid form, disturbances of vasoregulation (eg, edema) and abnormalities of other innervated tissues (skin, muscle, bone) can appear. Because of these various symptoms and the difficulty in identifying causative lesions, complex regional pain syndrome is difficult to treat or cure. Complex regional pain syndrome has not been systematically investigated; there are few controlled treatment trials for established complex regional pain syndrome. This article reviews the existing studies (even if preliminary) to direct clinicians toward the best options. Treatments for other neuropathic pain syndromes that may be efficacious for complex regional pain syndrome also are discussed. Some common treatments (eg, local anesthetic blockade of sympathetic ganglia) are not supported by the aggregate of published studies and should be used less frequently. Other treatments with encouraging published results (eg, neural stimulators) are not used often enough. We hope to encourage clinicians to rely more on evidence-supported treatments for complex regional pain syndrome.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Mitchell SW: Injuries of Nerves and Their Consequences. New York: Dover Publications; 1965. This book, originally published in 1872 and reprinted in 1965, provided the first accurate description of complex regional pain syndrome II (or as Mitchell called it, causalgia) as it occurred during the American Civil War. His magnificent case descriptions have been validated but never surpassed by any other author. Still relevant today, this book is required reading for any clinician or researcher with a serious interest in complex regional pain syndrome.Google Scholar
  2. 2.
    Evans JA: Reflex sympathetic dystrophy. Surg Gynecol Obstet 1946, 82:36–44.Google Scholar
  3. 3.
    Task Force on Taxonomy: Classification of Chronic Pain: Descriptions of Chronic Pain Syndromes and Definitions of Pain Terms. Seattle: IASP Press; 1994.Google Scholar
  4. 4.
    Allen G, Galer BS, Schwartz L: Epidemiology of complex regional pain syndrome: a retrospective chart review of 134 patients. Pain 1999, 80:539–544.PubMedCrossRefGoogle Scholar
  5. 5.
    van de Beek WJ, Schwartzman RJ, van Nes SI, et al.: Diagnostic criteria used in studies of reflex sympathetic dystrophy. Neurology 2002, 58:522–526. This recent article demonstrates how little impact the International Association for the Study of Pain (IASP) criteria of 1994 have had on study design and data analysis. Of 107 studies reviewed, only three used the exact IASP definition of complex regional pain syndrome (CRPS). This level of inconsistency makes it nearly impossible to compare study results. Although the IASP criteria are flawed, they should be used for all studies of CRPS until they are revised or replaced.PubMedGoogle Scholar
  6. 6.
    Oaklander AL, Rissmiller JG, Yang Y: Skin biopsies provide objective evidence of injury to nociceptors in patients with complex regional pain syndrome (reflex sympathetic dystrophy) [abstract]. Neurology 2000, 48:430A.Google Scholar
  7. 7.
    van der Laan L, ter Laak HJ, Gabreels-Festen A, et al.: Complex regional pain syndrome type I (RSD): pathology of skeletal muscle and peripheral nerve. Neurology 1998, 51:20–25.PubMedGoogle Scholar
  8. 8.
    Kemler MA, Barendse GA, van Kleef M, et al.: Spinal cord stimulation in patients with chronic reflex sympathetic dystrophy. N Engl J Med 2000, 343:618–624. This randomized, prospective study of 54 chronic patients with complex regional pain syndrome I compares spinal cord stimulation used in conjunction with physical therapy versus treatment with physical therapy alone. There were 24 patients in the spinal cord stimulation and physical therapy groups and 12 patients in the physical therapy group alone. The data demonstrated large improvement in pain and quality-of-life scores. Twenty-five percent of patients had complications requiring additional procedures, including surgeries. This study is of major importance because it demonstrates the greater improvements achievable with stimulators rather than medication alone.PubMedCrossRefGoogle Scholar
  9. 9.
    Campbell JN, Long DM: Peripheral nerve stimulation in the treatment of intractable pain. J Neurosurg 1976, 45:692–699.PubMedGoogle Scholar
  10. 10.
    Kingery WS: A critical review of controlled clinical trials for peripheral neuropathic pain and complex regional pain syndromes. Pain 1997, 73:123–139. Reviews 72 articles of controlled trials for complex regional pain syndrome (CRPS) and other types of peripheral neuropathic pain. Of those, 22 discussed CRPS. These studies support efficacy of corticosteroids in CRPS and provide limited or contradictory support for several therapies, including intranasal calcitonin, intravenous phentolamine, epidural clonidine, and Bier blocks with bretylium (but not with guanethidine or reserpine). This search identified no data to evaluate sympathetic ganglion blocks with local anesthetic, surgical sympathectomy, or physical therapy.PubMedCrossRefGoogle Scholar
  11. 11.
    Wilder RT, Berde CB, Wolohan M, et al.: Reflex sympathetic dystrophy in children: clinical characteristics and follow-up of seventy patients. J Bone Joint Surg Am 1992, 74:910–919.PubMedGoogle Scholar
  12. 12.
    Lee BH, Scharff L, Sethna NF, et al.: Physical therapy and cognitive-behavioral treatment for complex regional pain syndromes. J Pediatr 2002, 141:135–140.PubMedCrossRefGoogle Scholar
  13. 13.
    Oerlemans HM, Oostendorp RA, de Boo T, Goris RJ: Pain and reduced mobility in complex regional pain syndrome I: outcome of a prospective randomized, controlled clinical trial of adjuvant physical therapy versus occupational therapy. Pain 1999, 83:77–83.PubMedCrossRefGoogle Scholar
  14. 14.
    Bengtson K: Physical modalities for complex regional pain syndrome. Hand Clin 1997, 13:443–454.PubMedGoogle Scholar
  15. 15.
    Watson HK, Carlson L: Treatment of reflex sympathetic dystrophy of the hand with an active “stress loading” program. J Hand Surg [Am] 1987, 12:779–785.Google Scholar
  16. 16.
    Korpan MI, Dezu Y, Schneider B, et al.: Acupuncture in the treatment of posttraumatic pain syndrome. Acta Orthop Belg 1999, 65:197–201.PubMedGoogle Scholar
  17. 17.
    Spacek A, Horauf K, Kress HG: Pain management of complex regional pain syndrome (CRPS). Acta Anaesthesiol Scand Suppl 1998, 42:13–15.Google Scholar
  18. 18.
    Roy R, Thomas M, Matas M: Chronic pain and depression: a review. Compr Psychiatry 1984, 25:96–105.PubMedCrossRefGoogle Scholar
  19. 19.
    King JH, Nuss S: Reflex sympathetic dystrophy treated by electroconvulsive therapy: intractable pain, depression, and bilateral electrode ECT. Pain 1993, 55:393–396.PubMedCrossRefGoogle Scholar
  20. 20.
    Devor M, Govrin-Lippmann R, Raber P: Corticosteroids suppress ectopic neural discharge originating in experimental neuromas. Pain 1985, 22:127–137.PubMedCrossRefGoogle Scholar
  21. 21.
    Christensen K, Jensen EM, Noer I: The reflex dystrophy syndrome response to treatment with systemic corticosteroids. Acta Chir Scand 1982, 148:653–655.PubMedGoogle Scholar
  22. 22.
    Braus DF, Krauss JK, Strobel J: The shoulder-hand syndrome after stroke: a prospective clinical trial. Ann Neurol 1994, 36:728–733.PubMedCrossRefGoogle Scholar
  23. 23.
    Lee GW, Weeks PM: The role of bone scintigraphy in diagnosing reflex sympathetic dystrophy. J Hand Surg [Am] 1995, 20:458–463.CrossRefGoogle Scholar
  24. 24.
    Fraioli F, Fabbri A, Gnessi L, et al.: Subarachnoid injection of salmon calcitonin induces analgesia in man. Eur J Pharmacol 1982, 78:381–382.PubMedCrossRefGoogle Scholar
  25. 25.
    Ohya K, Yamada S, Felix R, Fleisch H: Effect of bisphosphonates on prostaglandin synthesis by rat bone cells and mouse calvaria in culture. Clin Sci (Lond) 1985, 69:403–411.Google Scholar
  26. 26.
    Van Offel JF, Schuerwegh AJ, Bridts CH, et al.: Influence of cyclic intravenous pamidronate on proinflammatory monocytic cytokine profiles and bone density in rheumatoid arthritis treated with low dose prednisolone and methotrexate. Clin Exp Rheumatol 2001, 19:13–20.PubMedGoogle Scholar
  27. 27.
    Gobelet C, Waldburger M, Meier JL: The effect of adding calcitonin to physical treatment on reflex sympathetic dystrophy. Pain 1992, 48:171–175.PubMedCrossRefGoogle Scholar
  28. 28.
    Bickerstaff DR, Kanis JA: The use of nasal calcitonin in the treatment of post-traumatic algodystrophy. Br J Rheumatol 1991, 30:291–294.PubMedCrossRefGoogle Scholar
  29. 29.
    Hamamci N, Dursun E, Ural C, Cakci A: Calcitonin treatment in reflex sympathetic dystrophy: a preliminary study. Br J Clin Pract 1996, 50:373–375.PubMedGoogle Scholar
  30. 30.
    Maillefert JF, Cortet B, Aho S: Pooled results from 2 trials evaluating biphosphonates in reflex sympathetic dystrophy. J Rheumatol 1999, 26:1856–1857.PubMedGoogle Scholar
  31. 31.
    Varenna M, Zucchi F, Ghiringhelli D, et al.: Intravenous clodronate in the treatment of reflex sympathetic dystrophy syndrome: a randomized, double blind, placebo-controlled study. J Rheumatol 2000, 27:1477–1483.PubMedGoogle Scholar
  32. 32.
    Max MB, Lynch SA, Muir J, et al.: Effects of desipramine, amitriptyline, and fluoxetine on pain in diabetic neuropathy. N Engl J Med 1992, 326:1250–1256.PubMedCrossRefGoogle Scholar
  33. 33.
    Max MB, Culnane M, Schafer SC, et al.: Amitriptyline relieves diabetic neuropathy pain in patients with normal or depressed mood. Neurology 1987, 37:589–596.PubMedGoogle Scholar
  34. 34.
    Watson CPN, Vernich L, Chipman M, Reed K: Nortriptyline versus amitriptyline in postherpetic neuralgia: a randomized trial. Neurology 1998, 51:1166–1171.PubMedGoogle Scholar
  35. 35.
    Mellick GA, Mellicy LB, Mellick LB: Gabapentin in the management of reflex sympathetic dystrophy. J Pain Symptom Manage 1995, 10:265–266.PubMedCrossRefGoogle Scholar
  36. 36.
    Wheeler DS, Vaux KK, Tam DA: Use of gabapentin in the treatment of childhood reflex sympathetic dystrophy. Pediatr Neurol 2000, 22:220–221.PubMedCrossRefGoogle Scholar
  37. 37.
    Kieburtz K, Simpson D, Yiannoutsos C, et al.: A randomized trial of amitriptyline and mexiletine for painful neuropathy in HIV infection: AIDS Clinical Trial Group 242 Protocol Team. Neurology 1998, 51:1682–1688.PubMedGoogle Scholar
  38. 38.
    Mao J, Chen LL: Systemic lidocaine for neuropathic pain relief. Pain 2000, 87:7–17.PubMedCrossRefGoogle Scholar
  39. 39.
    Veldman PH, Reynen HM, Arntz IE, Goris RJ: Signs and symptoms of reflex sympathetic dystrophy: prospective study of 829 patients. Lancet 1993, 342:1012–1016.PubMedCrossRefGoogle Scholar
  40. 40.
    Muizelaar JP, Kleyer M, Hertogs IA, DeLange DC: Complex regional pain syndrome (reflex sympathetic dystrophy and causalgia): management with the calcium channel blocker nifedipine and/or the alpha-sympathetic blocker phenoxybenzamine in 59 patients. Clin Neurol Neurosurg 1997, 99:26–30.PubMedCrossRefGoogle Scholar
  41. 41.
    Prough DS, McLeskey CH, Poehling GG, et al.: Efficacy of oral nifedipine in the treatment of reflex sympathetic dystrophy. Anesthesiology 1985, 62:796–799.PubMedCrossRefGoogle Scholar
  42. 42.
    Watson CP, Babul N: Efficacy of oxycodone in neuropathic pain: a randomized trial in postherpetic neuralgia. Neurology 1998, 50:1837–1841.PubMedGoogle Scholar
  43. 43.
    Becker WJ, Ablett DP, Harris CJ, Dold ON: Long-term treatment of intractable reflex sympathetic dystrophy with intrathecal morphine. Can J Neurol Sci 1995, 22:153–159.PubMedGoogle Scholar
  44. 44.
    Rowbotham MC, Davies PS, Verkempinck C, Galer BS: Lidocaine patch: double-blind controlled study of a new treatment method for post-herpetic neuralgia. Pain 1996, 65:39–44.PubMedCrossRefGoogle Scholar
  45. 45.
    Devers A, Galer BS: Topical lidocaine patch relieves a variety of neuropathic pain conditions: an open-label study. Clin J Pain 2000, 16:205–208.PubMedCrossRefGoogle Scholar
  46. 46.
    Caterina MJ, Leffler A, Malmberg AB, et al.: Impaired nociception and pain sensation in mice lacking the capsaicin receptor. Science 2000, 288:306–313.PubMedCrossRefGoogle Scholar
  47. 47.
    Simone DA, Nolano M, Johnson T, et al.: Intradermal injection of capsaicin in humans produces degeneration and subsequent reinnervation of epidermal nerve fibers: correlation with sensory function. J Neurosci 1998, 18:8947–8959.PubMedGoogle Scholar
  48. 48.
    Watson CP, Tyler KL, Bickers DR, et al.: A randomized vehiclecontrolled trial of topical capsaicin in the treatment of postherpetic neuralgia. Clin Ther 1993, 15:510–526.PubMedGoogle Scholar
  49. 49.
    Robbins WR, Staats PS, Levine JD, et al.: Treatment of intractable pain with topical large-dose capsaicin: preliminary report. Anesth Analg 1998, 86:579–583.PubMedCrossRefGoogle Scholar
  50. 50.
    Raja SN, Turnquist JL, Meleka S, Campbell JN: Monitoring adequacy of alpha-adrenoceptor blockade following systemic phentolamine administration. Pain 1996, 64:197–204.PubMedCrossRefGoogle Scholar
  51. 51.
    Davis KD, Treede RD, Raja SN, et al.: Topical application of clonidine relieves hyperalgesia in patients with sympathetically maintained pain. Pain 1991, 47:309–317.PubMedCrossRefGoogle Scholar
  52. 52.
    Gintautas J, Housny W, Kraynack BJ: Successful treatment of reflex sympathetic dystrophy by Bier block with lidocaine and clonidine. Proc West Pharmacol Soc 1999, 42:101.PubMedGoogle Scholar
  53. 53.
    Glynn C, O’Sullivan K: A double-blind randomized comparison of the effects of epidural clonidine, lignocaine, and the combination of clonidine and lignocaine in patients with chronic pain. Pain 1995, 64:337–343.CrossRefGoogle Scholar
  54. 54.
    Ghostine SY, Comair YG, Turner DM, et al.: Phenoxybenzamine in the treatment of causalgia: report of 40 cases. J Neurosurg 1984, 60:1263–1268.PubMedGoogle Scholar
  55. 55.
    Zollinger PE, Tuinebreijer WE, Kreis RW, Breederveld RS: Effect of vitamin C on frequency of reflex sympathetic dystrophy in wrist fractures: a randomized trial. Lancet 1999, 354:2025–2028.PubMedCrossRefGoogle Scholar
  56. 56.
    Bridenbaugh PO: Complications of local anesthetic neural blockade. In Neural Blockade in Clinical Anesthesia and Management of Pain. Edited by Cousins ML, Bridenbaugh PO. Philadelphia: Lippincott Williams & Wilkins; 1988:695–717.Google Scholar
  57. 57.
    Cepeda MS, Lau J, Carr DB: Defining the therapeutic role of local anesthetic sympathetic blockade in complex regional pain syndrome: a narrative and systematic review. Clin J Pain 2002, 18:216–233. This is the first rigorous meta-analysis to evaluate trials of local anesthetic sympathetic blockade for complex regional pain syndrome (CRPS). Twenty-nine studies that included 1144 patients were reviewed. Although study quality generally was poor in aggregate, efficacy was no greater than that expected from placebo. Local anesthetic sympathetic blockade is the most common procedure for CRPS, but this study should change that.PubMedCrossRefGoogle Scholar
  58. 58.
    Hilgenhurst G: The Bier block after 80 years: a historical review. Reg Anesth 1990, 15:2–5.PubMedGoogle Scholar
  59. 59.
    Hannington-Kiff JG: Intravenous regional sympathetic block with guanethidine. Lancet 1974, 1:1019–1020.PubMedCrossRefGoogle Scholar
  60. 60.
    McKain CW, Urban BJ, Goldner JL: The effects of intravenous regional guanethidine and reserpine: a controlled study. J Bone Joint Surg Am 1983, 65:808–811.PubMedGoogle Scholar
  61. 61.
    Hord AH, Rooks MD, Stephens BO, et al.: Intravenous regional bretylium and lidocaine for treatment of reflex sympathetic dystrophy: a randomized, double-blind study. Anesth Analg 1992, 74:818–821.PubMedCrossRefGoogle Scholar
  62. 62.
    Jones NC, Pugh SC: The addition of tenoxicam to prilocaine for intravenous regional anesthesia. Anaesthesia 1996, 51:446–448.PubMedCrossRefGoogle Scholar
  63. 63.
    Zyluk A: The reasons for poor response to treatment of posttraumatic reflex sympathetic dystrophy. Acta Orthop Belg 1998, 64:309–313.PubMedGoogle Scholar
  64. 64.
    Kaplan R, Claudio M, Kepes E, Gu XF: Intravenous guanethidine in patients with reflex sympathetic dystrophy. Acta Anaesthesiol Scand 1996, 40:1216–1222.PubMedGoogle Scholar
  65. 65.
    Ramamurthy S, Hoffman J: Intravenous regional guanethidine in the treatment of reflex sympathetic dystrophy/causalgia: a randomized, double-blind study. Guanethidine Study Group. Anesth Analg 1995, 81:718–723.PubMedCrossRefGoogle Scholar
  66. 66.
    Bennett GJ, Burchiel KJ, Buchser E, et al.: Clinical guidelines for intraspinal infusion: report of an expert panel. J Pain Symptom Manage 2000, 20:S37-S43.PubMedCrossRefGoogle Scholar
  67. 67.
    Lin TC, Wong CS, Chen FC, et al.: Long-term epidural ketamine, morphine, and bupivacaine attenuate reflex sympathetic dystrophy neuralgia. Can J Anaesth 1998, 45:175–177.PubMedGoogle Scholar
  68. 68.
    Lundborg C, Dahm P, Nitescu P, et al.: Clinical experience using intrathecal (IT) bupivacaine infusion in three patients with complex regional pain syndrome type I (CRPS-I). Acta Anaesthesiol Scand 1999, 43:667–678.PubMedCrossRefGoogle Scholar
  69. 69.
    Iyadomi M, Iyadomi I, Kumamoto E, et al.: Presynaptic inhibition by baclofen of miniature EPSCs and IPSCs in substantia gelatinosa neurons of the adult rat spinal dorsal horn. Pain 2000, 85:385–393.PubMedCrossRefGoogle Scholar
  70. 70.
    Ford B, Greene P, Louis ED, et al.: Use of intrathecal baclofen in the treatment of patients with dystonia. Arch Neurol 1996, 53:1241–1246.PubMedGoogle Scholar
  71. 71.
    van Hilten BJ, van de Beek WJ, Hoff JI, et al.: Intrathecal baclofen for the treatment of dystonia in patients with reflex sympathetic dystrophy. N Engl J Med 2000, 343:625–630.PubMedCrossRefGoogle Scholar
  72. 72.
    Wiesenfeld-Hallin Z, Aldskogius H, Grant G, et al.: Central inhibitory dysfunctions: mechanisms and clinical implications. Behav Brain Sci 1997, 20:420–425.PubMedCrossRefGoogle Scholar
  73. 73.
    Taira T, Kawamura H, Tanikawa T, et al.: A new approach to control central deafferentation pain: spinal intrathecal baclofen. Stereotact Funct Neurosurg 1995, 65:101–105.PubMedCrossRefGoogle Scholar
  74. 74.
    Zuniga RE, Perera S, Abram SE: Intrathecal baclofen: a useful agent in the treatment of well-established complex regional pain syndrome. Reg Anesth Pain Med 2002, 27:90–93.PubMedCrossRefGoogle Scholar
  75. 75.
    Kofler M, Kronenberg MF, Rifici C, et al.: Epileptic seizures associated with intrathecal baclofen application. Neurology 1994, 44:25–27.PubMedGoogle Scholar
  76. 76.
    Thimineur MA, Saberski L: Complex regional pain syndrome type I (RSD) or peripheral mononeuropathy: a discussion of three cases. Clin J Pain 1996, 12:145–150.PubMedCrossRefGoogle Scholar
  77. 77.
    Long DM, Erickson D, Campbell J, North R: Electrical stimulation of the spinal cord and peripheral nerves for pain control. Appl Neurophysiol 1980, 44:207–217.CrossRefGoogle Scholar
  78. 78.
    Hosobuchi Y: Subcortical electrical stimulation for control of intractable pain in humans: report of 122 cases (1970–1984). J Neurosurg 1986, 64:543–553.PubMedCrossRefGoogle Scholar
  79. 79.
    Mazars GJ: Intermittent stimulation of nucleus ventralis posterolateralis for intractable pain. Surg Neurol 1975, 4:93–95.PubMedGoogle Scholar
  80. 80.
    Melzack R, Wall PD: Pain mechanisms: a new theory. Science 1965, 150:971–979.PubMedCrossRefGoogle Scholar
  81. 81.
    Meyerson BA, Linderoth B: Mechanisms of spinal cord stimulation in neuropathic pain. Neurol Res 2000, 22:285–292.PubMedGoogle Scholar
  82. 82.
    Cui JG, Sollevi A, Linderoth B, Meyerson BA: Adenosine receptor activation suppresses tactile hypersensitivity and potentiates spinal cord stimulation in mononeuropathic rats. Neurosci Lett 1997, 223:173–176.PubMedCrossRefGoogle Scholar
  83. 83.
    Cui JG, O’Connor WT, Ungerstedt U, et al.: Spinal cord stimulation attenuates augmented dorsal horn release of excitatory amino acids in mononeuropathy via a GABAergic mechanism. Pain 1997, 73:87–95.PubMedCrossRefGoogle Scholar
  84. 84.
    Linderoth B, Gazelius B, Franck J, Brodin E: Dorsal column stimulation induces release of serotonin and substance P in the cat dorsal horn. Neurosurgery 1992, 31:289–296.PubMedCrossRefGoogle Scholar
  85. 85.
    Robaina FJ, Rodriguez JL, de Vera JA, Martin MA: Transcutaneous electrical nerve stimulation and spinal cord stimulation for pain relief in reflex sympathetic dystrophy. Stereotact Funct Neurosurg 1989, 52:53–62.PubMedCrossRefGoogle Scholar
  86. 86.
    Kumar K, Toth C, Nath RK, Laing P: Epidural spinal cord stimulation for treatment of chronic pain: some predictors of success: a 15-year experience. Surg Neurol 1998, 50:110–120.PubMedCrossRefGoogle Scholar
  87. 87.
    Bennett DS, Aló KM, Oakley J, Feler CA: Spinal cord stimulation for complex regional pain syndrome I (RSD): a retrospective multicenter experience from 1995 to 1998 of 101 patients. Neuromodulation 1999, 2:202–210.CrossRefGoogle Scholar
  88. 88.
    North RB, Kidd DH, Zahurak M, et al.: Spinal cord stimulation for chronic, intractable pain: experience over two decades. Neurosurgery 1993, 32:384–395.PubMedCrossRefGoogle Scholar
  89. 89.
    Hord E, Cohen S, Ahmed S, et al.: Does sympathetic block predict success in complex regional pain syndrome patients undergoing spinal cord stimulation [abstract]? J Pain 2002, 3:46.Google Scholar
  90. 90.
    Schon LC, Shores JL, Levin GB: A short-term prospective analysis of peripheral nerve stimulation for intractable lower extremity nerve pain [abstract ]. J Pain 2002, 3:46.Google Scholar

Copyright information

© Current Science Inc 2003

Authors and Affiliations

  • E. Daniela Hord
    • 1
  • Anne Louise Oaklander
    • 1
  1. 1.Massachusetts General HospitalBostonUSA

Personalised recommendations