Richtlijn 'Complex regionaal pijnsyndroom type I'

- The development and treatment of the complex regional pain syndrome type I (CRPS-1) are a subject of much discussion. - Using the method for the development of evidence-based guidelines, a multidisciplinary guideline for the diagnosis and treatment of this syndrome has been drawn up. - The diagnosis of CRPS-I is based on the clinical observation of signs and symptoms. - For pain treatment, the WHO analgesic ladder is advised up to step 2. - In case of pain of a neuropathic nature, anticonvulsants and tricyclic antidepressants may be considered. - For the treatment of inflammatory symptoms, free-radical scavengers (dimethylsulphoxide or acetylcysteine) are advised. - In order to enhance peripheral blood flow, vasodilatory medication may be considered. - Percutaneous sympathetic blockades may be used for a cold extremity if vasodilatory medication produces insufficient effect. - To decrease functional limitations, standardised physiotherapy and occupational therapy are advised. - To prevent the occurrence of CRPS-I after wrist fractures, the use of vitamin C is recommended. - Adequate perioperative analgesia, limitation of operation time and limited use of bloodlessness are advised for the secondary prevention of CRPS-I. Use of regional anaesthetic techniques can also be considered in this connection.