Reflex Sympathetic Dystrophy of the Face: Current Treatment Recommendations

Arden, Richard L.; Bahu, Samer J.; Zuazu, Marcos A.; Berguer, Ramón

doi:10.1097/00005537-199803000-00023

Cited by 32 publications

(15 citation statements)

References 12 publications

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“…A search of the literature produced 13 articles of which 11 were reviewable. These are summarized in Table 3 21–31 . Of the 2 articles not used, one was in French without an English translation and the other was a case report and discussion of the diagnostic criteria for reflex sympathetic dystrophy (RSD).…”

Section: The Blocksmentioning

confidence: 99%

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Sympathetic Blocks: The Evidence

Day

2008

Pain Practice

131

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The sympathetic nervous system has been implicated in numerous pain syndromes ranging from neuropathic pain to vascular pain to visceral pain. In light of this, sympathetic ganglia have been the target of local anesthetic blockade to determine the sympathetic role in the transmission of pain. If analgesia is afforded with local anesthetic blockade, chemical or thermal neurolysis have been utilized to attempt to provide long-term relief. Despite frequent use of minimally invasive sympathetic blocks and neurolysis by pain practitioners, their efficacy for providing analgesia has been sparsely reported in the literature. Many case reports and case series have been published, but few placebo-controlled, blinded studies exist. This manuscript will review the literature on sympathetic blocks and summarize existing studies for each of the sympathetic blocks. The goal is to provide past, current, and future pain physicians with evidence that they can use to provide appropriate care for their patients.

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Section: The Blocksmentioning

confidence: 99%

“…All studies received a 1C grade. Ten of the 11 were case reports, case series, and a retrospective study, but were performed for the aforementioned diagnosis 21–30 . The study by Price et al.…”

Section: The Blocksmentioning

confidence: 99%

Sympathetic Blocks: The Evidence

Day

2008

Pain Practice

131

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“…Trauma ranks as the leading provocative event for CRPS1, and one report suggests that two‐thirds of CRPS1 cases in the United States occur postoperatively or after an injury 25 . In 10% to 26% of the cases, no precipitating event can be found 26 …”

Section: Pathophysiologymentioning

confidence: 97%

Chronic Regional Pain Syndrome, Type 1: Part I

Dunn¹

2000

AORN Journal

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Chronic regional pain syndrome refers to a class of disorders thought to involve common neuropathic and clinical features. These disorders usually are caused by injury, and they manifest in pain and sensory changes that are disproportionate in intensity, distribution, and duration to the underlying pathology. The result of these injuries is significant impairment of motor function over time. This article is divided into two parts. Part I discusses background information such as pain, pathophysiology, diagnosis, clinical stages, and the most common treatment modality, sympathetic nerve blocks. Part II, discusses alternate treatment modalities, such as sympathectomy, physical therapy, stimulators, trigger point injections, acupuncture, tourniquet effects, placebo effects, and amputation. AORN J 72 (Sept 2000) 421–449.

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“…The clinical picture of this syndrome in the orofacial region may vary from patient to patient. Pain usually compromises the topography innervated by the local sympathetic system that accompanies the vascular system of this area, comprising regions of the dermatomes 1,3 . In addition, the patient may present other local alterations, such as changes in color and skin temperature, hypersalivation, and, in some rare cases, trophic alterations and local skin edema 2 .…”

Section: Introductionmentioning

confidence: 99%

Complex regional pain syndrome in the orofacial region. Case report

Santos¹,

Sales²,

Asano³

et al. 2018

Brazilian Journal of Pain

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BACKGROUND AND OBJECTIVES: The complex regional pain syndrome is characterized by presenting autonomic, sensory and motor difficult to control changes of the chronic evolution. Its pathophysiology and treatment are not fully defined, and the search for an increasingly effective treatment is a subject of medical concern. The involvement of the orofacial region has an even rarer incidence, and the literature reports only 14 cases in five decades. The objective of this report was to warn physicians and researchers about the importance of a correct diagnosis and to show the possibility of controlling this dysfunction with conservative treatment. CASE REPORT: A 68-year-old female patient, who after a facial trauma and three subsequent surgical procedures, developed orofacial complex regional pain syndrome. Several therapeutic regimens were performed, and after the last one she became completely asymptomatic: oxcarbazepine (900mg/day), morphine-controlled liberation (120mg/day), fluoxetine (40mg/day) and clonazepam (2mg/day), electrotherapy and oral rehabilitation. CONCLUSION: The diagnosis criteria for complex regional pain syndrome recommended by the International Association for the Study of Pain, revised in 2007, should be followed. The treatment of this neuropathic syndrome includes anticonvulsants, tricyclics, opioids, electrotherapy and somatic and stellate ganglion block, the latter when the pain is maintained by the sympathetic nervous system. In this report of an orofacial complex regional pain syndrome II, pain control was shown without the need for sympathetic ganglion block, which can be a warning to the medical class to a correct diagnosis and an effective and less invasive treatment.RESUMO JUSTIFICATIVA E OBJETIVOS: A síndrome complexa de dor regional se caracteriza por apresentar alterações autonômicas, sensitivas e motoras de evolução crônica de difícil controle. Sua fisiopatologia não está totalmente definida e a busca por um tratamento cada vez mais eficaz é objeto de preocupação médica. O comprometimento da região orofacial tem uma incidência ainda mais rara e a literatura relata apenas 14 casos em cinco décadas. O objetivo deste relato foi alertar médicos e pesquisadores para a importância de um diagnóstico correto e mostrar a possibilidade de controle dessa disfunção com o tratamento conservador. RELATO DO CASO: Paciente do sexo feminino, 68 anos, após trauma facial e três intervenções cirúrgicas posteriores, desenvolveu quadro de síndrome complexa de dor regional orofacial. Foram realizados vários esquemas terapêuticos, o último dos quais tornou-a completamente assintomática: oxcarbazepina (900mg/dia), morfina de liberação controlada (120mg/dia), fluoxetina (40mg/dia) e clonazepam (2mg/dia), eletroterapia e reabilitação oral. CONCLUSÃO: Os critérios de diagnóstico para a síndrome complexa de dor regional, preconizados pela International Association for the Study of Pain, revisados em 2007, devem ser seguidos. O tratamento desta síndrome neuropática inclui anticonvulsivantes, tricíclicos e opioide...

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Reflex Sympathetic Dystrophy of the Face: Current Treatment Recommendations

Cited by 32 publications

References 12 publications

Sympathetic Blocks: The Evidence

Sympathetic Blocks: The Evidence

Chronic Regional Pain Syndrome, Type 1: Part I

Complex regional pain syndrome in the orofacial region. Case report

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