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Treatment of complex regional pain syndrome type I of the hand with a series of intravenous regional sympathetic blocks with guanethidine and lidocaine

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Abstract

The aim of this study was to evaluate the efficacy of guanethidine and lidocaine in the treatment of complex regional pain syndrome (CRPS) type I of the hand. Seventeen patients, aged between 33 and 72 years, suffering from CRPS type I of the hand received two series of intravenous regional sympathetic block (Bier's block) sessions with guanethidine and lidocaine according to the following therapeutic protocol: (1) 5 sessions (once every second day) composed of intravenous regional administration of 15 mg guanethidine and 1 mg lidocaine/kg body weight each and (2) 20 sessions (twice a week) composed of intravenous regional administration of 10 mg guanethidine and 1 mg lidocaine/kg body weight each. Complete disappearance of pain and return of the normal function and movement of the extremity were achieved. No side effects were observed. The above-described therapeutic protocol method resulted in excellent pain relief and full restoration of both function and range of movement of the affected extremity in 17 patients suffering from CRPS type I of the hand.

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References

  1. Doury P (1988) Algodystrophy. Reflex sympathetic dystrophy syndrome. Clin Rheumatol 7:173–180

    Article  PubMed  CAS  Google Scholar 

  2. Kozin F (1994) Reflex sympathetic dystrophy syndrome. Curr Opin Rheumatol 6:210–216

    Article  PubMed  CAS  Google Scholar 

  3. Veldman PH, Reynen HM, Arntz IE, Goris RJ (1993) Signs and symptoms of reflex sympathetic dystrophy: prospective study of 829 patients. Lancet 342:1012–1016

    Article  PubMed  CAS  Google Scholar 

  4. Merskey H, Bogduk N (1994) Classification of chronic pain: descriptions of chronic pain syndromes and definitions of pain terms, 2nd edn. IASP, Seattle, pp 40–43

    Google Scholar 

  5. Teasell RW, Potter P, Moulin D (1994) Reflex sympathetic dystrophy involving three limbs: a case study. Arch Phys Med Rehabil 75:1008–1010

    PubMed  CAS  Google Scholar 

  6. Schiffenbauer J, Fagien M (1993) Reflex sympathetic dystrophy involving multiple extremities. J Rheumatol 1993; 20:165–169

    PubMed  CAS  Google Scholar 

  7. Price DD, Bush FM, Long S, Harkins SW (1994) A comparison of pain measurement characteristics of mechanical visual analogue and simple numerical rating scales. Pain 56:217–226

    Article  PubMed  CAS  Google Scholar 

  8. Bier A (1908) Über einen neuen Weg Lokalanesthesie an der Gliedmassen zu erzeugen. Arch Klin Chir 96:1007–1016

    Google Scholar 

  9. Stanton-Hicks M, Baron R, Boas R, Gordh T, Harden N, Hendler N, Koltzenburg M, Raj P, Wilder R (1998) Complex regional pain syndromes: guidelines for therapy. Clin J Pain 14:155–166

    Article  PubMed  CAS  Google Scholar 

  10. Soucacos PN, Diznitsas LA, Beris AE, Xenakis TA, Malizos KN (1997) Reflex sympathetic dystrophy of the upper extremity. Clinical features and response to multimodal management. Hand Clin 13:339–354

    PubMed  CAS  Google Scholar 

  11. Oerlemans HM, Oostendorp RA, de Boo T, Goris RJ (1999) Pain and reduced mobility in complex regional pain syndrome I: outcome of a prospective randomised controlled clinical trial of adjuvant physical therapy versus occupational therapy. Pain 83:77–83

    Article  PubMed  CAS  Google Scholar 

  12. Oerlemans HM, Oostendorp RA, de Boo T, van der Laan L, Severens JL, Goris JA (2000) Adjuvant physical therapy versus occupational therapy in patients with reflex sympathetic dystrophy/complex regional pain syndrome type I. Arch Phys Med Rehabil 81:49–56

    Article  PubMed  CAS  Google Scholar 

  13. Bounameaux HM, Hellemans H, Verhaeghe R (1984) Ketanserin in chronic sympathetic dystrophy. An acute controlled trial. Clin Rheumatol 3:556–557

    Article  PubMed  CAS  Google Scholar 

  14. Hanna MH, Peat SJ (1989) Ketanserin in reflex sympathetic dystrophy. A double-blind placebo controlled cross-over trial. Pain 38:145–150

    Article  PubMed  CAS  Google Scholar 

  15. Kettler RE, Abram SE (1988) Intravenous regional droperidol in the management of reflex sympathetic dystrophy: a double-blind, placebo-controlled, crossover study. Anesthesiology 69:933–936

    Article  PubMed  CAS  Google Scholar 

  16. Verdugo RJ, Ochoa JL (1994) Sympathetically maintained pain. I. Phentolamine block questions the concept. Neurology 44:1003–1010

    PubMed  CAS  Google Scholar 

  17. Schurmann M, Gradl G, Wizgal I, Tutic M, Moser C, Azad S, Beyer A (2001) Clinical and physiologic evaluation of stellate ganglion blockade for complex regional pain syndrome type I. Clin J Pain 17:94–100

    Article  PubMed  CAS  Google Scholar 

  18. Rauck RL, Eisenach JC, Jackson K, Young LD, Southern J (1993) Epidural clonidine treatment for refractory reflex sympathetic dystrophy. Anesthesiology 79:1163–1169

    Article  PubMed  CAS  Google Scholar 

  19. Reuben SS, Sklar J (2002) Intravenous regional anesthesia with clonidine in the management of complex regional pain syndrome of the knee. J Clin Anesth 14:87–91

    Article  PubMed  CAS  Google Scholar 

  20. AbuRahma AF, Robinson PA, Powell M, Bastug D, Boland JP (1994) Sympathectomy for reflex sympathetic dystrophy: factors affecting outcome. Ann Vasc Surg 8:372–379

    Article  PubMed  CAS  Google Scholar 

  21. Olcott C 4th, Eltherington LG, Wilcosky BR, Shoor PM, Zimmerman JJ, Fogarty TJ (1991) Reflex sympathetic dystrophy—the surgeon's role in management. J Vasc Surg 14:488–492

    Article  PubMed  Google Scholar 

  22. Bandyk DF, Johnson BL, Kirkpatrick AF, Novotney ML, Back MR, Schmacht DC (2002) Surgical sympathectomy for reflex sympathetic dystrophy syndromes. J Vasc Surg 35:269–277

    Article  PubMed  Google Scholar 

  23. Adami S, Fossaluzza V, Gatti D, Fracassi E, Braga V (1997) Biphosphonate therapy on reflex sympathetic dystrophy syndrome. Ann Rheum Dis 56:201–204

    Article  PubMed  CAS  Google Scholar 

  24. Manicourt DH, Brasseur JP, Boutsen Y, Depreseux G, Devogelaer JP (2004) Role of alendronate in therapy for posttraumatic complex regional pain syndrome type I of the lower extremity. Arthritis Rheum 50:3690–3697

    Article  PubMed  CAS  Google Scholar 

  25. Varenna M, Zucchi F, Ghiringelli D, Binelli L, Bevilacqua M, Bettica P, Sinigaglia L (2000) Intravenous clodronate in the treatment of reflex sympathetic dystrophy syndrome. A randomized, double blind, placebo controlled study. J Rheumatol 27:1477–1483

    PubMed  CAS  Google Scholar 

  26. Cortet B, Flipo RM, Coquerelle P, Duquesnoy B, Delcambre B (1997) Treatment of severe, recalcitrant reflex sympathetic dystrophy: assessment of efficacy and safety of the second generation bisphosphonate pamidronate. Clin Rheumatol 16:51–56

    Article  PubMed  CAS  Google Scholar 

  27. Robinson JN, Sandom J, Chapman PT (2004) Efficacy of pamidronate in complex regional pain syndrome type I. Pain Med 5:276–280

    Article  PubMed  Google Scholar 

  28. Kubalek I, Fain O, Paries J, Kettaneh A, Thomas M (2001) Treatment of reflex sympathetic dystrophy with pamidronate: 29 cases. Rheumatology (Oxford) 40:1394–1397

    Article  CAS  Google Scholar 

  29. Gobelet C, Waldburger M, Meier JL (1992) The effect of adding calcitonin to physical treatment on reflex sympathetic dystrophy. Pain 48:171–175

    Article  PubMed  CAS  Google Scholar 

  30. Hamamci N, Dursun N, Ural C, Cakci A (1996) Calcitonin treatment in reflex sympathetic dystrophy: a preliminary study. Br J Clin Pract 50:373–375

    PubMed  CAS  Google Scholar 

  31. Bickerstaff DR, Kanis JA (1991) The use of nasal calcitonin in the treatment of post-traumatic algodystrophy. Br J Rheumatol 30:291–294

    Article  PubMed  CAS  Google Scholar 

  32. Christensen K, Jensen EM, Noer I (1982) The reflex dystrophy syndrome response to treatment with systemic corticosteroids. Acta Chir Scand 148:653–655

    PubMed  CAS  Google Scholar 

  33. Tountas AA, Noguchi A (1991) Treatment of posttraumatic reflex sympathetic dystrophy syndrome (RSDS) with intravenous blocks of a mixture of corticosteroid and lidocaine: a retrospective review of 17 consecutive cases. J Orthop Trauma 5:412–419

    Article  PubMed  CAS  Google Scholar 

  34. Papadopoulos GS, Xenakis TA, Arnaoutoglou E, Tefa L, Kitsoulis PB (2001) The treatment of reflex sympathetic dystrophy in a 9-year-old boy with long standing symptoms. Minerva Anestesiol 67:659–663

    PubMed  CAS  Google Scholar 

  35. Zyluk A (1998) Results of the treatment of posttraumatic reflex sympathetic dystrophy of the upper extremity with regional intravenous blocks of methylprednisolone and lidocaine. Acta Orthop Belg 64:452–456

    PubMed  CAS  Google Scholar 

  36. Korpan MI, Dezu Y, Schneider B, Leitha T, Fialka-Moser V (1999) Acupuncture in the treatment of posttraumatic pain syndrome. Acta Orthop Belg 65:197–201

    PubMed  CAS  Google Scholar 

  37. Fialka V, Resch KL, Ritter-Dietrich D, Alacamlioglu Y, Chen O, Leitha T, Kluger R, Ernst E (1993) Acupuncture for reflex sympathetic dystrophy. Arch Intern Med 153:661–665

    Article  PubMed  CAS  Google Scholar 

  38. Wu WH, Bandilla E, Ciccone DS, Yang J, Cheng SC, Carner N, Wu Y, Shen R (1999) Effects of qigong on late-stage complex regional pain syndrome. Altern Ther Health Med 5:45–54

    PubMed  CAS  Google Scholar 

  39. Price DD, Long S, Wilsey B, Rafii A (1998) Analysis of peak magnitude and duration of analgesia produced by local anesthetics injected into sympathetic ganglia of complex regional pain syndrome patients. Clin J Pain 14:216–226

    Article  PubMed  CAS  Google Scholar 

  40. Arias LM, Bartkowski R, Grossman KL, Schwartzman RJ, Tom CM (1989) Sufentanil stellate ganglion injection in the treatment of refractory reflex sympathetic dystrophy. Reg Anesth 14:90–92

    PubMed  CAS  Google Scholar 

  41. Lin TC, Wong CS, Chen FC, Lin SY, Ho ST (1998) Long-term epidural ketamine, morphine and bupivacaine attenuate reflex sympathetic dystrophy neuralgia. Can J Anaesth 45:175–177

    PubMed  CAS  Google Scholar 

  42. Kumar K, Nath RK, Toth C (1997) Spinal cord stimulation is effective in the management of reflex sympathetic dystrophy. Neurosurgery 40:503–508

    Article  PubMed  CAS  Google Scholar 

  43. Forouzanfar T, Kemler MA, Weber WE, Kessels AG, van Kleef M (2004) Spinal cord stimulation in complex regional pain syndrome: cervical and lumbar devices are comparably effective. Br J Anaesth 92:348–353

    Article  PubMed  CAS  Google Scholar 

  44. Kemler MA, De Vet HC, Barendse GA, Van Den Wildenberg FA, Van Kleef M (2004) The effect of spinal cord stimulation in patients with chronic reflex sympathetic dystrophy: two years' follow-up of the randomized controlled trial. Ann Neurol 55:13–18

    Article  PubMed  Google Scholar 

  45. Kemler MA, Barendse GA, van Kleef M, Egbrink MG (2000) Pain relief in complex regional pain syndrome due to spinal cord stimulation does not depend on vasodilation. Anesthesiology 92:1653–1660

    Article  PubMed  CAS  Google Scholar 

  46. Kemler MA, Barendse GA, Van Kleef M, Van Den Wildenberg FA, Weber WE (1999) Electrical spinal cord stimulation in reflex sympathetic dystrophy: retrospective analysis of 23 patients. J Neurosurg Spine 90:79–83

    Article  CAS  Google Scholar 

  47. Robaina FJ, Dominguez M, Diaz M, Rodriguez JL, de Vera JA (1989) Spinal cord stimulation for relief of chronic pain in vasospastic disorders of the upper limbs. Neurosurgery 24:63–67

    Article  PubMed  CAS  Google Scholar 

  48. Barolat G, Schwartzman R, Woo R (1989) Epidural spinal cord stimulation in the management of reflex sympathetic dystrophy. Stereotact Funct Neurosurg 53:29–39

    Article  PubMed  CAS  Google Scholar 

  49. Kemler MA, Reulen JP, Barendse GA, van Kleef M, de Vet HC, van den Wildenberg FA (2001) Impact of spinal cord stimulation on sensory characteristics in complex regional pain syndrome type I: a randomized trial. Anesthesiology 95:72–80

    Article  PubMed  CAS  Google Scholar 

  50. Wallace MS, Ridgeway BM, Lebung AY, Gerayli A, Yaksh TL (2000) Concentration-effect relationship of intravenous lidocaine on the allodynia of complex regional pain syndrome types I and II. Anesthesiology 92:75–83

    Article  PubMed  CAS  Google Scholar 

  51. Hord AH, Rooks MD, Stephens BO, Rogers HG, Fleming LL (1992) Intravenous regional bretylium and lidocaine for treatment of reflex sympathetic dystrophy: a randomized, double-blind study. Anesth Analg 74:818–821

    Article  PubMed  CAS  Google Scholar 

  52. Linchitz RM, Raheb JC (1999) Subcutaneous infusion of lidocaine provides effective pain relief for CRPS patients. Clin J Pain 15:67–72

    Article  PubMed  CAS  Google Scholar 

  53. van de Vusse AC, Stomp-van den Berg SG, Kessels AH, Weber WE (2004) Randomised controlled trial of gabapentin in complex regional pain syndrome type 1 [ISRCTN84121379]. BMC Neurol 4:13

    Article  PubMed  CAS  Google Scholar 

  54. Mellick GA, Mellick LB (1997) Reflex sympathetic dystrophy treated with gabapentin. Arch Phys Med Rehabil 78:98–105

    Article  PubMed  CAS  Google Scholar 

  55. Birklein F, Claus D, Riedl B, Neundorfer B, Handwerker HO (1997) Effects of cutaneous histamine application in patients with sympathetic reflex dystrophy. Muscle Nerve 20:1389–1395

    Article  PubMed  CAS  Google Scholar 

  56. Muizelaar JP, Kleyer M, Hertogs IA, DeLange DC (1997) 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 99:26–30

    Article  PubMed  CAS  Google Scholar 

  57. Becker WJ, Ablett DP, Harris CJ, Dold ON (1995) Long term treatment of intractable reflex sympathetic dystrophy with intrathecal morphine. Can J Neurol Sci 22:153–159

    PubMed  CAS  Google Scholar 

  58. Zuniga RE, Perera S, Abram SE (2002) Intrathecal baclofen: a useful agent in the treatment of well-established complex regional pain syndrome. Reg Anesth Pain Med 27:90–93

    Article  PubMed  Google Scholar 

  59. Lundborg C, Dahm P, Nitescu P, Appelgren L, Curelaru I (1999) Clinical experience using intrathecal (IT) bupivacaine infusion in three patients with complex regional pain syndrome type I (CRPS-I). Acta Anaesthesiol Scand 43:667–678

    Article  PubMed  CAS  Google Scholar 

  60. Farah BA (1993) Ketorolac in reflex sympathetic dystrophy. Clin Neuropharmacol 16:88–89

    Article  PubMed  CAS  Google Scholar 

  61. King JH, Nuss S (1993) Reflex sympathetic dystrophy treated by electroconvulsive therapy: intractable pain, depression, and bilateral electrode ECT. Pain 55:393–396

    Article  PubMed  CAS  Google Scholar 

  62. Karakurum G, Pirbudak L, Oner U, Gulec A, Karadasli H, Satana T (2003) Sympathetic blockade and amitriptyline in the treatment of reflex sympathetic dystrophy. Int J Clin Pract 57:585–587

    PubMed  CAS  Google Scholar 

  63. Gintautas J, Housny W, Kraynack BJ (1999) Successful treatment of reflex sympathetic dystrophy by bier block with lidocaine and clonidine. Proc West Pharmacol Soc 42:101

    PubMed  CAS  Google Scholar 

  64. Cheshire WP, Snyder CR (1990) Treatment of reflex sympathetic dystrophy with topical capsaicin. Case report. Pain 42:307–311

    Article  PubMed  CAS  Google Scholar 

  65. Hannington-Kiff JG (1974) Intravenous regional sympathetic block with guanethidine. Lancet 1:1019–1020

    Article  PubMed  CAS  Google Scholar 

  66. Glynn CJ, Basedow RW, Walsh JA (1981) Pain relief following post-ganglionic sympathetic blockade with i.v. guanethidine. Br J Anaesth 53:1297–1302

    PubMed  CAS  Google Scholar 

  67. Benelli S, Conoscente F, Movilia PG, Restelli L, Francucci B, Grossi E (1983) Regional intravenous guanethidine vs. stellate ganglion block in reflex sympathetic dystrophies: a randomized trial. Pain 16:297–307

    Article  PubMed  Google Scholar 

  68. Field J, Atkins RM (1993) Effect of guanethidine on the natural history of post-traumatic algodystrophy. Ann Rheum Dis 52:467–469

    Article  PubMed  CAS  Google Scholar 

  69. Field J, Monk C, Atkins RM (1993) Objective improvements in algodystrophy following regional intravenous guanethidine. J Hand Surg [Br] 18:339–342

    Article  CAS  Google Scholar 

  70. Vijayan R, Low KH (1993) Pain relief with intravenous regional guanethidine in post-traumatic reflex sympathetic dystrophy—a case report. Med J Malaysia 48:236–239

    PubMed  CAS  Google Scholar 

  71. Verre M, De Santis F, Glyronakis S, Grande AM, Renzi A, Santangelo E, Tortorella V, Varano M (2002) Pharmacological sympathetic block in complex regional pain syndrome. Clin Ter 153:367–372

    PubMed  CAS  Google Scholar 

  72. Bonezzi C, Miotti D, Bettaglio R, Stephen R (1994) Electromotive administration of guanethidine for treatment of reflex sympathetic dystrophy: a pilot study in eight patients. J Pain Symptom Manage 9:39–43

    Article  PubMed  CAS  Google Scholar 

  73. Nielsen FB, Olesen AS (1992) Guanethidine blockade for palliative treatment in reflex dystrophy. Ugeskr Laeger 154:1500–1502

    PubMed  CAS  Google Scholar 

  74. Jeandel P, Prigent D, Gilette B, Imbert P, Angel G, Aubert M (1989) Treatment of reflex algoneurodystrophies by sympathetic blockade with guanethidine. Ann Med Interne (Paris) 140:166–168

    CAS  Google Scholar 

  75. Eulry F, Lechevalier D, Pats B, Alliaume C, Crozes P, Vasseur P, Coutant G, Felten D, Pattin S (1991) Regional intravenous guanethidine blocks in algodystrophy. Clin Rheumatol 10:377–383

    Article  PubMed  CAS  Google Scholar 

  76. Jacquemoud G, Chamay A (1982) Treatment of algodystrophy using intravenous guanethidine regional block. Ann Chir Main 1:57–64

    Article  PubMed  CAS  Google Scholar 

  77. Jadad AR, Carroll D, Glynn CJ, McQuay HJ (1995) Intravenous regional sympathetic blockade for pain relief in reflex sympathetic dystrophy: a systematic review and a randomized double-blind crossover study. J Pain Symptom Manage 10:13–20

    Article  PubMed  CAS  Google Scholar 

  78. Rocco AG, Kaul AF, Reisman RM, Gallo JP, Lief PA (1989) A comparison of regional intravenous guanethidine and reserpine in reflex sympathetic dystrophy. A controlled, randomized, double-blind cross-over study. Clin J Pain 5:205–209

    Article  PubMed  CAS  Google Scholar 

  79. Blanchard J, Ramamurthy S, Walsh N, Hoffman J, Schoenfeld L (1990) Intravenous regional sympatholysis: a double-blind comparison of guanethidine, reserpine and normal saline. J Pain Symptom Manage 5:357–361

    Article  PubMed  CAS  Google Scholar 

  80. Kaplan R, Claudio M, Kepes E, Gu XF (1996) Intravenous guanethidine in patients with reflex sympathetic dystrophy. Acta Anaesthesiol Scand 40:1216–1222

    PubMed  CAS  Google Scholar 

  81. Geertzen JHB, deBruijn H, deBruijn-Kofman AT, Arendzen JH (1994) Reflex sympathetic dystrophy: early treatment and psychological aspects. Arch Phys Med Rehabil 75:442–446

    Article  PubMed  CAS  Google Scholar 

  82. Livingstone JA, Atkins RM (2002) Intravenous regional guanethidine blockade in the treatment of post-traumatic complex regional pain syndrome type 1 (algodystrophy) of the hand. J Bone Joint Surg Br 84:380–386

    Article  PubMed  CAS  Google Scholar 

  83. Ramamurthy S, Hoffman J (1995) Intravenous regional guanethidine in the treatment of reflex sympathetic dystrophy/causalgia: a randomized, double-blind study. Guanethidine Study Group. Anesth Analg 81:718–723

    Article  PubMed  CAS  Google Scholar 

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Paraskevas, K.I., Michaloglou, A.A., Briana, D.D. et al. Treatment of complex regional pain syndrome type I of the hand with a series of intravenous regional sympathetic blocks with guanethidine and lidocaine. Clin Rheumatol 25, 687–693 (2006). https://doi.org/10.1007/s10067-005-0122-0

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