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Complex Regional Pain SyndromeRecommendationsDescriptionStrength of recommendationLevel of evidenceSympathetic blocks with local anesthetics should not be used for the treatment of CRPS Moderate againstModerateDescriptionStrength of recommendationLevel of evidenceThoracic blocks (T2-3) with ropivacaine and triamcinolone could be used for the treatment of upper extremity CRPS. WeakLowDescriptionStrength of recommendationLevel of evidenceIntravenous regional blocks with guanethidine should not be used for the treatment of CRPS Moderate againstmoderateDescriptionStrength of recommendationLevel of evidenceSpinal Cord Stimulation should be used in CRPS patients who are refractory to conservative treatments. ModerateModerateDescriptionStrength of recommendationLevel of evidenceDorsal Root Ganglion Stimulation should be used for patients with CRPS of the lower extremity who are refractory to conservative treatments, and is superior to spinal cord stimulation at 12 months ModerateModerateDescriptionStrength of recommendationLevel of evidencePeripheral nerve stimulation could be considered in CRPS patients. Very weakVery lowDescriptionStrength of recommendationLevel of evidenceLow dose IV ketamine could be considered in CRPS patients.WeakModerateClinical questionWhat is the place for interventional pain treatments in the treatment algorithm of Complex Regional Pain Syndrome (CRPS).Researched treatment optionsFor patients with Complex Regional Pain Syndrome the following treatments were studied:Cervical and lumbar sympathetic blockade Thoracic sympathetic blockade Intravenous regional blockade with guanethidineEpidural/DRG neurostimulationPeripheral nerve stimulationKetamine intravenouslyAny comparators including sham, no treatment or other active treatment techniques were eligible. Inclusion was not restricted based on outcomeMethodsFor the search strategy, we refer to the special section on methods in the introduction.Results of literature searchA number of potentially relevant reviews published between 2010 and 2015 for CRPS were identified. One review by Straube et al. ADDIN EN.CITE <EndNote><Cite><Author>Straube</Author><Year>2013</Year><RecNum>12280</RecNum><DisplayText><style face="superscript">1</style></DisplayText><record><rec-number>12280</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="1488823743">12280</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Straube, S.</author><author>Derry, S.</author><author>Moore, R. A.</author><author>Cole, P.</author></authors></contributors><auth-address>Institute of Occupational, Social and Environmental Medicine, University Medical Center Gottingen, Waldweg 37 B, Gottingen, Germany, D-37073.</auth-address><titles><title>Cervico-thoracic or lumbar sympathectomy for neuropathic pain and complex regional pain syndrome</title><secondary-title>Cochrane Database Syst Rev</secondary-title></titles><periodical><full-title>Cochrane Database Syst Rev</full-title></periodical><pages>CD002918</pages><number>9</number><keywords><keyword>Catheter Ablation/*methods</keyword><keyword>Complex Regional Pain Syndromes/*therapy</keyword><keyword>Humans</keyword><keyword>Leg/innervation</keyword><keyword>Neck</keyword><keyword>Neuralgia/*therapy</keyword><keyword>Phenol</keyword><keyword>Randomized Controlled Trials as Topic</keyword><keyword>Sympathectomy/*methods</keyword><keyword>Sympathectomy, Chemical/methods</keyword><keyword>Sympatholytics</keyword><keyword>Thorax</keyword></keywords><dates><year>2013</year><pub-dates><date>Sep 02</date></pub-dates></dates><isbn>1469-493X (Electronic)
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ADDIN EN.CITE.DATA 2 which was identified in the previous guideline. ADDIN EN.CITE <EndNote><Cite><Author>van Eijs</Author><Year>2011</Year><RecNum>7123</RecNum><DisplayText><style face="superscript">3</style></DisplayText><record><rec-number>7123</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="0">7123</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>van Eijs, F.</author><author>Stanton-Hicks, M.</author><author>Van Zundert, J.</author><author>Faber, C. G.</author><author>Lubenow, T. R.</author><author>Mekhail, N.</author><author>van Kleef, M.</author><author>Huygen, F.</author></authors></contributors><auth-address>Department of Anesthesiology and Pain Therapy, St. Elisabeth Hospital, Tilburg, The Netherlands.</auth-address><titles><title>Evidence-based interventional pain medicine according to clinical diagnoses. 16. Complex regional pain syndrome</title><secondary-title>Pain Pract</secondary-title></titles><periodical><full-title>Pain Pract</full-title></periodical><pages>70-87</pages><volume>11</volume><number>1</number><dates><year>2011</year><pub-dates><date>Jan</date></pub-dates></dates><accession-num>20807353</accession-num><urls><related-urls><url> Two reviews, one of ketamine conducted by AzariPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5BemFyaTwvQXV0aG9yPjxZZWFyPjIwMTI8L1llYXI+PFJl
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ADDIN EN.CITE.DATA 4 and one conducted by Tran ADDIN EN.CITE <EndNote><Cite><Author>Tran</Author><Year>2010</Year><RecNum>2259</RecNum><DisplayText><style face="superscript">5</style></DisplayText><record><rec-number>2259</rec-number><foreign-keys><key app="EN" db-id="w09dw9et8sfxe4ev094vsttywzet9p5aaxv2" timestamp="1427365245">2259</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Tran, De Q. H.</author><author>Duong, Silvia</author><author>Bertini, Pietro</author><author>Finlayson, Roderick J.</author></authors></contributors><auth-address>Department of Anesthesia, Montreal General Hospital, McGill University, Montreal, H3G 1A4, Quebec, Canada. de_tran@</auth-address><titles><title>Treatment of complex regional pain syndrome: a review of the evidence</title><secondary-title>Canadian Journal of Anaesthesia</secondary-title><alt-title>Can J Anaesth</alt-title></titles><periodical><full-title>CANADIAN JOURNAL OF ANAESTHESIA</full-title><abbr-1>Can J Anaesth</abbr-1></periodical><alt-periodical><full-title>CANADIAN JOURNAL OF ANAESTHESIA</full-title><abbr-1>Can J Anaesth</abbr-1></alt-periodical><pages>149-66</pages><volume>57</volume><number>2</number><keywords><keyword>Animals</keyword><keyword>*Complex Regional Pain Syndromes/th [Therapy]</keyword><keyword>*Diphosphonates/tu [Therapeutic Use]</keyword><keyword>Electric Stimulation Therapy/mt [Methods]</keyword><keyword>Humans</keyword><keyword>Imagery (Psychotherapy)/mt [Methods]</keyword><keyword>Randomized Controlled Trials as Topic</keyword><keyword>0 (Diphosphonates)</keyword></keywords><dates><year>2010</year><pub-dates><date>Feb</date></pub-dates></dates><accession-num>20054678</accession-num><urls></urls><custom1> FC</custom1><custom2>DAF</custom2><custom3>PP</custom3><custom4> LS (Ovid/MEDLINE. 2_KSR Pain_Med1) Searched 29.9.14. Entry date 2010-2013 (inclusive)</custom4><custom6> </custom6><language>English</language><modified-date>Neuralgia/</modified-date></record></Cite></EndNote>5 covering a range of treatments appeared to have been superseded by later reviews.We identified a review by Xu and colleagues of intravenous therapies for CRPS but this was only reported as a conference abstract and could not therefore be included.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5YdTwvQXV0aG9yPjxZZWFyPjIwMTM8L1llYXI+PFJlY051
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ADDIN EN.CITE.DATA 7 and an overview of reviews and trials on ketamine for CRPS ADDIN EN.CITE <EndNote><Cite><Author>Connolly</Author><Year>2015</Year><RecNum>38329</RecNum><DisplayText><style face="superscript">8</style></DisplayText><record><rec-number>38329</rec-number><foreign-keys><key app="EN" db-id="w09dw9et8sfxe4ev094vsttywzet9p5aaxv2" timestamp="1431328088">38329</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Connolly, S. B.</author><author>Prager, J. P.</author><author>Harden, R. N.</author></authors></contributors><auth-address>Center for Pain Studies, Rehabilitation Institute of Chicago, Chicago, Illinois, USA.</auth-address><titles><title>A Systematic Review of Ketamine for Complex Regional Pain Syndrome</title><secondary-title>Pain Med</secondary-title></titles><periodical><full-title>PAIN MEDICINE</full-title><abbr-1>Pain Med</abbr-1></periodical><edition>2015/01/15</edition><dates><year>2015</year><pub-dates><date>Jan 13</date></pub-dates></dates><isbn>1526-4637 (Electronic)
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ADDIN EN.CITE.DATA 9 which covers a range of interventions and a systematic review by Stanton focusing on local anesthetic sympathetic blockade. ADDIN EN.CITE <EndNote><Cite><Author>Stanton</Author><Year>2013</Year><RecNum>12045</RecNum><DisplayText><style face="superscript">10</style></DisplayText><record><rec-number>12045</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="1471965434">12045</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Stanton, T. R.</author><author>Wand, B. M.</author><author>Carr, D. B.</author><author>Birklein, F.</author><author>Wasner, G. L.</author><author>O'Connell, N. E.</author></authors></contributors><auth-address>Neuroscience Research Australia, Randwick, Australia.</auth-address><titles><title>Local anaesthetic sympathetic blockade for complex regional pain syndrome</title><secondary-title>Cochrane Database Syst Rev</secondary-title></titles><periodical><full-title>Cochrane Database Syst Rev</full-title></periodical><pages>CD004598</pages><number>8</number><keywords><keyword>Adult</keyword><keyword>*Anesthetics, Local</keyword><keyword>Autonomic Nerve Block/*methods</keyword><keyword>Causalgia/drug therapy</keyword><keyword>Child</keyword><keyword>Complex Regional Pain Syndromes/*drug therapy</keyword><keyword>Humans</keyword><keyword>Randomized Controlled Trials as Topic</keyword><keyword>Reflex Sympathetic Dystrophy/drug therapy</keyword></keywords><dates><year>2013</year></dates><isbn>1469-493X (Electronic)
1361-6137 (Linking)</isbn><accession-num>23959684</accession-num><urls><related-urls><url> Sympathetic blockade with local anestheticsLiterature overviewA systematic review was found, in which local anesthetic blockade (LASB) of the sympathetic chain was applied to treat CRPS. ADDIN EN.CITE <EndNote><Cite><Author>Stanton</Author><Year>2013</Year><RecNum>12045</RecNum><DisplayText><style face="superscript">10</style></DisplayText><record><rec-number>12045</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="1471965434">12045</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Stanton, T. R.</author><author>Wand, B. M.</author><author>Carr, D. B.</author><author>Birklein, F.</author><author>Wasner, G. L.</author><author>O'Connell, N. E.</author></authors></contributors><auth-address>Neuroscience Research Australia, Randwick, Australia.</auth-address><titles><title>Local anaesthetic sympathetic blockade for complex regional pain syndrome</title><secondary-title>Cochrane Database Syst Rev</secondary-title></titles><periodical><full-title>Cochrane Database Syst Rev</full-title></periodical><pages>CD004598</pages><number>8</number><keywords><keyword>Adult</keyword><keyword>*Anesthetics, Local</keyword><keyword>Autonomic Nerve Block/*methods</keyword><keyword>Causalgia/drug therapy</keyword><keyword>Child</keyword><keyword>Complex Regional Pain Syndromes/*drug therapy</keyword><keyword>Humans</keyword><keyword>Randomized Controlled Trials as Topic</keyword><keyword>Reflex Sympathetic Dystrophy/drug therapy</keyword></keywords><dates><year>2013</year></dates><isbn>1469-493X (Electronic)
1361-6137 (Linking)</isbn><accession-num>23959684</accession-num><urls><related-urls><url> It included blockades of the stellate ganglion for the treatment of CRPS at the upper extremity and the lumbar sympathetic ganglion to treat CRPS of the lower extremity. Twelve studies were included in the review (n = 386), all of which were found to be at high or unclear risk of bias. Three small studies compared local anesthetic sympathetic blockade (LASB) to placebo or sham procedure. Two small studies (23 participants in intervention arms) did not demonstrate significant short-term benefit for LASB in reducing pain by 50% when compared to placebo, Risk Ratio 1.18 (95% CI: 0.76 to 1.84). Five out of 8 eight trials compared LASB to another active intervention and found no difference in pain outcomes between sympathetic block and other active treatments. In two other differences were small and/or short-lived. Conclusion: Quality of the evidence DescriptionModerate There is evidence of moderate quality that sympathetic blocks with local anesthetics are not effective for the treatment of complex regional pain syndrome.Stanton et al 2013ConsiderationsIn the systematic review ADDIN EN.CITE <EndNote><Cite><Author>Stanton</Author><Year>2013</Year><RecNum>12045</RecNum><DisplayText><style face="superscript">10</style></DisplayText><record><rec-number>12045</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="1471965434">12045</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Stanton, T. R.</author><author>Wand, B. M.</author><author>Carr, D. B.</author><author>Birklein, F.</author><author>Wasner, G. L.</author><author>O'Connell, N. E.</author></authors></contributors><auth-address>Neuroscience Research Australia, Randwick, Australia.</auth-address><titles><title>Local anaesthetic sympathetic blockade for complex regional pain syndrome</title><secondary-title>Cochrane Database Syst Rev</secondary-title></titles><periodical><full-title>Cochrane Database Syst Rev</full-title></periodical><pages>CD004598</pages><number>8</number><keywords><keyword>Adult</keyword><keyword>*Anesthetics, Local</keyword><keyword>Autonomic Nerve Block/*methods</keyword><keyword>Causalgia/drug therapy</keyword><keyword>Child</keyword><keyword>Complex Regional Pain Syndromes/*drug therapy</keyword><keyword>Humans</keyword><keyword>Randomized Controlled Trials as Topic</keyword><keyword>Reflex Sympathetic Dystrophy/drug therapy</keyword></keywords><dates><year>2013</year></dates><isbn>1469-493X (Electronic)
1361-6137 (Linking)</isbn><accession-num>23959684</accession-num><urls><related-urls><url> five studies reported adverse effects, all with minor effects on the measured outcome parameters reported.RecommendationDescriptionStrength of recommendationLevel of evidenceSympathetic blocks with local anesthetics should not be used for the treatment of complex regional pain syndrome Moderate againstModerateThoracic sympathetic blockLiterature overviewOne double-blind sham-controlled RCT has been performed PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5kZSBPbGl2ZWlyYSBSb2NoYTwvQXV0aG9yPjxZZWFyPjIw
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ADDIN EN.CITE.DATA 11 in 37 patients with CRPS type I of the upper extremity ≥ 6 months, without pain relief (NRS ≥ 4) after 4 weeks of standardized rehabilitation and pharmacological treatment. Patients received either an injection of 5ml of 0.75% ropivacaine with 5ml 2% triamcinolone in the T2 sympathetic thoracic ganglion lateral to the T2 vertebra (TSB), or an identical injection in the subcutaneous space at the T2 level as add on therapy to standardized pharmacological and physical therapy. At 1 month, Back Pain Index (BPI) average pain intensity was not significantly different between groups: TSB 3.59 (sd 3.2), control 4.84 (sd 2.7), p = 0.249. At 12 months, the TSB group had lower scores: TSB 3.47 (sd 3.5) vs control 5.86 (sd 2.9), p = 0.046. Baseline values were 5.35 (sd 2.1) and 6.37 (sd 1.9), respectively, pain had decreased significantly in the TSB group (p < 0.05). The TSB group scored better on other BPI variables, MPQ and on the NPSI evoked pain sub scores too. All TSB patients had had > 2 °C temperature difference after the block. ConclusionsQuality of the evidence DescriptionLow There is evidence of low quality that thoracic sympathetic blocks (T2-3) with ropivacaine and triamcinolone reduce pain in patients with upper extremity complex regional pain syndrome significantly better than a subcutaneous injection at 12 months post treatmentDe Oliveira Rocha R et al. 2014ConsiderationsIn this single identified trial, there were no major adverse events, number of minor adverse events was similar between the groups.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5kZSBPbGl2ZWlyYSBSb2NoYTwvQXV0aG9yPjxZZWFyPjIw
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ADDIN EN.CITE.DATA 11 In this study there were problems with blinding and 7 out of 36 patients lost to follow up at 12 months. It is a small study,17 patients in the TSB group and 19 in the control group.This trial has to be replicated to come to more definite conclusions so thoracic sympathetic block can be advised but preferably study related. RecommendationDescriptionStrength of recommendationLevel of evidenceThoracic blocks (T2-3) with ropivacaine and triamcinolone could be used for the treatment of upper extremity complex regional pain syndrome. weakLowIntravenous regional blocks guanethidineLiterature overviewThe recommendations in the previous guideline were based on a double-blind crossover study with saline, high-dose and low-dose guanethidine, no significant differences between groups was found. ADDIN EN.CITE <EndNote><Cite><Author>Jadad</Author><Year>1995</Year><RecNum>448</RecNum><DisplayText><style face="superscript">12</style></DisplayText><record><rec-number>448</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="0">448</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Jadad, A. R.</author><author>Carroll, D.</author><author>Glynn, C. J.</author><author>McQuay, H. J.</author></authors></contributors><auth-address>Oxford Regional Pain Relief Unit, Nuffield Department of Anesthetics, University of Oxford, England.</auth-address><titles><title>Intravenous regional sympathetic blockade for pain relief in reflex sympathetic dystrophy: a systematic review and a randomized, double-blind crossover study</title><secondary-title>J Pain Symptom Manage</secondary-title></titles><periodical><full-title>J Pain Symptom Manage</full-title></periodical><pages>13-20</pages><volume>10</volume><number>1</number><keywords><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Aged, 80 and over</keyword><keyword>*Autonomic Nerve Block</keyword><keyword>Cross-Over Studies</keyword><keyword>Double-Blind Method</keyword><keyword>Female</keyword><keyword>Human</keyword><keyword>Injections, Intravenous</keyword><keyword>Male</keyword><keyword>Middle Age</keyword><keyword>*Palliative Care</keyword><keyword>Reflex Sympathetic Dystrophy/*therapy</keyword></keywords><dates><year>1995</year><pub-dates><date>Jan</date></pub-dates></dates><accession-num>7536227</accession-num><urls><related-urls><url> All groups reported less than 30% pain reduction; there was no evidence of a dose-response for guanethidine. The trial was stopped prematurely after serious adverse events in 2 patients with the high dose of guanethidine. A double-blind controlled multicenter RCT comparing IVRB with guanethidine or placebo in a group of 60 CRPS patients found no differences in long-term outcome. ADDIN EN.CITE <EndNote><Cite><Author>Ramamurthy</Author><Year>1995</Year><RecNum>453</RecNum><DisplayText><style face="superscript">13</style></DisplayText><record><rec-number>453</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="0">453</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Ramamurthy, S.</author><author>Hoffman, J.</author></authors></contributors><auth-address>Department of Anesthesiology, University of Texas Health Science Center at San Antonio 78284-7838, USA.</auth-address><titles><title>Intravenous regional guanethidine in the treatment of reflex sympathetic dystrophy/causalgia: a randomized, double-blind study. Guanethidine Study Group</title><secondary-title>Anesth Analg</secondary-title></titles><periodical><full-title>Anesth Analg</full-title></periodical><pages>718-23</pages><volume>81</volume><number>4</number><keywords><keyword>Adult</keyword><keyword>Causalgia/*therapy</keyword><keyword>Double-Blind Method</keyword><keyword>Female</keyword><keyword>Guanethidine/*administration & dosage</keyword><keyword>Human</keyword><keyword>Injections, Intravenous</keyword><keyword>Male</keyword><keyword>*Nerve Block</keyword><keyword>Pain Measurement</keyword><keyword>Reflex Sympathetic Dystrophy/*therapy</keyword><keyword>Support, Non-U.S. Gov't</keyword><keyword>Sympatholytics/*administration & dosage</keyword></keywords><dates><year>1995</year><pub-dates><date>Oct</date></pub-dates></dates><accession-num>7574000</accession-num><urls><related-urls><url> In another RCT, in a group of 57 CRPS patients, comparing IVRB with guanethidine to saline, again, no significant long-term differences were found. PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5MaXZpbmdzdG9uZTwvQXV0aG9yPjxZZWFyPjIwMDI8L1ll
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ADDIN EN.CITE.DATA 14 Conclusion Quality of the evidence DescriptionModerateThere is evidence of moderate quality that intravenous regional blocks with guanethidine do not provide better pain reduction than placebo at 1, 3 and 6 months for the treatment of complex regional pain syndromeJadad et al. 1995; Ramamurthy S, and Hoffman J.1995ConsiderationsThe trials did not show difference in reduction of pain between the intravenous injection and control group. The trial of Jadad was stopped because of serious adverse effects with a high dose of guanethidineRecommendationsDescriptionStrength of recommendationLevel of evidenceIntravenous regional blocks with guanethidine should not be used for the treatment of complex regional pain syndromeModerate againstmoderateSpinal cord stimulation, DRG stimulationLiterature overviewThe 6 months effect of this therapy in patients with CRPS has been demonstrated in a randomized trial. ADDIN EN.CITE <EndNote><Cite><Author>Kemler</Author><Year>2000</Year><RecNum>326</RecNum><DisplayText><style face="superscript">15</style></DisplayText><record><rec-number>326</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="0">326</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Kemler, M. A.</author><author>Barendse, G. A.</author><author>van Kleef, M.</author><author>de Vet, H. C.</author><author>Rijks, C. P.</author><author>Furnee, C. A.</author><author>van den Wildenberg, F. A.</author></authors></contributors><auth-address>Department of Surgery, Maastricht University Hospital, The Netherlands. mkeml@shee.azm.nl</auth-address><titles><title>Spinal cord stimulation in patients with chronic reflex sympathetic dystrophy</title><secondary-title>N Engl J Med</secondary-title></titles><periodical><full-title>N Engl J Med</full-title></periodical><pages>618-24</pages><volume>343</volume><number>9</number><keywords><keyword>Adult</keyword><keyword>Chronic Disease</keyword><keyword>*Electric Stimulation Therapy</keyword><keyword>*Electrodes, Implanted</keyword><keyword>Female</keyword><keyword>Human</keyword><keyword>Male</keyword><keyword>Middle Age</keyword><keyword>Pain Measurement</keyword><keyword>Physical Therapy Techniques</keyword><keyword>Prospective Studies</keyword><keyword>Reflex Sympathetic Dystrophy/*therapy</keyword><keyword>Regression Analysis</keyword><keyword>Sickness Impact Profile</keyword><keyword>*Spinal Cord</keyword><keyword>Support, Non-U.S. Gov't</keyword></keywords><dates><year>2000</year><pub-dates><date>Aug 31</date></pub-dates></dates><accession-num>10965008</accession-num><urls><related-urls><url> In this study, 54 patients with CRPS were included and randomized 2:1 to receive SCS and physical therapy or a standard regimen of physical therapy alone. Thirty-six patients were assigned to and treated with a test SCS. Twenty-four of those reported a reduction in pain and in these patients a definitive system was implanted. Eighteen patients only received physical therapy. Six months posttreatment, the intention to treat (ITT) analysis showed a clear reduction in pain intensity in the group with stimulated patients despite the fact that only 24 of the 36 patients were actually treated with SCS. The positive effects on pain and global perceived effect remained in an ITT analysis 2 years after implantation. ADDIN EN.CITE <EndNote><Cite><Author>Kemler</Author><Year>2004</Year><RecNum>2329</RecNum><DisplayText><style face="superscript">16</style></DisplayText><record><rec-number>2329</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="0">2329</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Kemler, M. A.</author><author>De Vet, H. C.</author><author>Barendse, G. A.</author><author>Van Den Wildenberg, F. A.</author><author>Van Kleef, M.</author></authors></contributors><auth-address>Department of Plastic Surgery, Medical Center Leeuwarden, Leeuwarden. Marius.Kemler@ZNB.nl</auth-address><titles><title>The effect of spinal cord stimulation in patients with chronic reflex sympathetic dystrophy: two years' follow-up of the randomized controlled trial</title><secondary-title>Ann Neurol</secondary-title></titles><periodical><full-title>Ann Neurol</full-title></periodical><pages>13-8</pages><volume>55</volume><number>1</number><keywords><keyword>Adolescent</keyword><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Chronic Disease/therapy</keyword><keyword>*Electric Stimulation Therapy/methods</keyword><keyword>Follow-Up Studies</keyword><keyword>Humans</keyword><keyword>Middle Aged</keyword><keyword>Pain/*therapy</keyword><keyword>Physical Therapy Modalities</keyword><keyword>Prospective Studies</keyword><keyword>Quality of Life</keyword><keyword>Recovery of Function</keyword><keyword>Reflex Sympathetic Dystrophy/*therapy</keyword><keyword>Spinal Cord/*physiology</keyword><keyword>Treatment Outcome</keyword></keywords><dates><year>2004</year><pub-dates><date>Jan</date></pub-dates></dates><accession-num>14705107</accession-num><urls><related-urls><url> </url></related-urls></urls></record></Cite></EndNote>16 Pain reduction was identical in patients treated with a cervical lead for CRPS in the upper extremity compared to a lumbar lead for CRPS in the lower extremity. ADDIN EN.CITE <EndNote><Cite><Author>Forouzanfar</Author><Year>2004</Year><RecNum>2331</RecNum><DisplayText><style face="superscript">17</style></DisplayText><record><rec-number>2331</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="0">2331</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Forouzanfar, T.</author><author>Kemler, M. A.</author><author>Weber, W. E.</author><author>Kessels, A. G.</author><author>van Kleef, M.</author></authors></contributors><auth-address>Department of Anaesthesiology, University Hospital Maastricht, Maastricht, The Netherlands.</auth-address><titles><title>Spinal cord stimulation in complex regional pain syndrome: cervical and lumbar devices are comparably effective</title><secondary-title>Br J Anaesth</secondary-title></titles><periodical><full-title>Br J Anaesth</full-title></periodical><pages>348-53</pages><volume>92</volume><number>3</number><keywords><keyword>Adult</keyword><keyword>Cervical Vertebrae</keyword><keyword>Complex Regional Pain Syndromes/*therapy</keyword><keyword>Electric Stimulation Therapy/adverse effects/*methods</keyword><keyword>Electrodes, Implanted</keyword><keyword>Female</keyword><keyword>Follow-Up Studies</keyword><keyword>Humans</keyword><keyword>Lumbar Vertebrae</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Pain Measurement</keyword><keyword>Prospective Studies</keyword><keyword>*Spinal Cord</keyword><keyword>Treatment Outcome</keyword></keywords><dates><year>2004</year><pub-dates><date>Mar</date></pub-dates></dates><accession-num>14742334</accession-num><urls><related-urls><url> </url></related-urls></urls></record></Cite></EndNote>17ConclusionQuality of the evidence DescriptionModerate There is evidence of moderate quality that spinal cord stimulation reduces pain for up to 2 years in patients with complex regional pain syndrome. 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ADDIN EN.CITE.DATA 18 Theoretically, there are several reasons for the diminishment of effect in the Kemler studies. First, just 2/3 of the patients in the active group received a stimulator. The ITT analysis has a negative effect on the active treatment group. Secondly, newer knowledge about the pathophysiology of CRPS, learns that CRPS is not a stable disease. During the disease, all kind of disturbances can develop which can have a negative effect on the outcome of stimulation therapies. Newer research shows that with changes in the way of stimulation (for example higher frequencies of stimulation) the effect of the therapy can be re-established. A recent review on the clinical and cost-effectiveness of SCS in the management of chronic neuropathic pain or ischemic pain suggests that this treatment is effective in reducing the chronic neuropathic pain of CRPS type 1 PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TaW1wc29uPC9BdXRob3I+PFllYXI+MjAwOTwvWWVhcj48
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ADDIN EN.CITE.DATA 19.Serious adverse events are rare. Adverse events are more frequent and mainly due to technical issues. During the more recent years technology is improved, which seems to result in a lower frequency of technical issues.After the literature search, 2 newer studies about a variation on epidural neurostimulation, namely Dorsal Root Ganglion stimulation were published. A prospective case series, in which CRPS patients received neuromodulation of the Dorsal Root Ganglia (DRG) showed relief of chronic pain and other symptoms associated with CRPS PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5WYW4gQnV5dGVuPC9BdXRob3I+PFllYXI+MjAxNTwvWWVh
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ADDIN EN.CITE.DATA 20. In this trial 8 of 11 patients had a successful trial, 7 made it through to 12 months. At 12 months 6 out of 7 (85.7%) were still experiencing pain relief of ≥ 50% compared to baseline. Significant improvements reported in Mood (POMS) and Quality of Life (EQ-5D)A randomized controlled trial (ACCURATE study) PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5EZWVyPC9BdXRob3I+PFllYXI+MjAxNzwvWWVhcj48UmVj
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ADDIN EN.CITE.DATA 21 shows superiority for DRG stimulation over conventional SCS stimulation at 3 and 12 months follow up in patients with CRPS of the lower extremity. The DRG group is statistically non-inferior and superior in the composite endpoint of safety and efficacy (A subject was considered a primary endpoint success if the subject met 3 criteria: >50% pain relief in their primary area of pain at the end of the trial phase, and >50% pain relief in their primary area of pain at the 3 month visit post implant, and freedom from stimulation-induced neurological deficit through 3 months) at the 3 and 12-month visits compared to the Control SCS group. DRG Stimulation showed a greater percentage of subjects that responded to therapy versus commercially available SCS at 3 months post implantation of neurostimulator (INS) (81.2% vs. 55.7%) and 12 months post INS (74.2% vs. 53.0%). DRG demonstrated greater improvements in Quality of Life measures, psychological disposition and physical/activity levels. DRG produced less positional effects on paresthesia intensity when compared to the SCS control group.The frequency of adverse events is slightly higher in DRG stimulation in comparison to the SCS stimulation. A learning curve for the implantation of DRG stimulators is possibly responsible for this difference.After the literature search a first placebo-controlled trial on neurostimulation in CRPS was published. A N =1 randomized placebo controlled trial with 29 CRPS patients ADDIN EN.CITE <EndNote><Cite><Author>Kriek</Author><Year>2017</Year><RecNum>12283</RecNum><DisplayText><style face="superscript">22</style></DisplayText><record><rec-number>12283</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="1488882669">12283</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Kriek, N.</author><author>Groeneweg, J. G.</author><author>Stronks, D. L.</author><author>de Ridder, D.</author><author>Huygen, F. J.</author></authors></contributors><auth-address>Center for Pain Medicine, Erasmus MC - University Medical Center Rotterdam, The Netherlands.
Department of Surgical Sciences, Section of Neurosurgery, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.</auth-address><titles><title>Preferred frequencies and waveforms for spinal cord stimulation in patients with complex regional pain syndrome: A multicentre, double-blind, randomized and placebo-controlled crossover trial</title><secondary-title>Eur J Pain</secondary-title></titles><periodical><full-title>Eur J Pain</full-title></periodical><pages>507-519</pages><volume>21</volume><number>3</number><dates><year>2017</year><pub-dates><date>Mar</date></pub-dates></dates><isbn>1532-2149 (Electronic)
1090-3801 (Linking)</isbn><accession-num>27714945</accession-num><urls><related-urls><url>, showed a statistically and clinical significant effect on pain for different stimulation modes over placebo after a test period of 2 weeks. Neuromodulation therapies are expensive, but cost effective. ADDIN EN.CITE <EndNote><Cite><Author>Kemler</Author><Year>2002</Year><RecNum>325</RecNum><DisplayText><style face="superscript">23</style></DisplayText><record><rec-number>325</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="0">325</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Kemler, M. A.</author><author>Furnee, C. A.</author></authors></contributors><auth-address>Department of Surgery, Maastricht University Hospital, Maastricht, The Netherlands. kemlerm@mzh.nl</auth-address><titles><title>Economic evaluation of spinal cord stimulation for chronic reflex sympathetic dystrophy</title><secondary-title>Neurology</secondary-title></titles><periodical><full-title>Neurology</full-title></periodical><pages>1203-9</pages><volume>59</volume><number>8</number><keywords><keyword>Chronic Disease</keyword><keyword>Comparative Study</keyword><keyword>Electric Stimulation Therapy/*economics/statistics & numerical data</keyword><keyword>Female</keyword><keyword>Follow-Up Studies</keyword><keyword>Health Services Research/*economics</keyword><keyword>Human</keyword><keyword>Linear Models</keyword><keyword>Male</keyword><keyword>Physical Therapy Techniques/economics/statistics & numerical data</keyword><keyword>Quality of Life</keyword><keyword>Reflex Sympathetic Dystrophy/*economics/*therapy</keyword><keyword>*Spinal Cord</keyword><keyword>Support, Non-U.S. Gov't</keyword><keyword>Treatment Outcome</keyword></keywords><dates><year>2002</year><pub-dates><date>Oct 22</date></pub-dates></dates><accession-num>12391348</accession-num><urls><related-urls><url> Considering that part of the patients respond to more conservative treatment, the use of neuromodulation therapies must be reserved for patients who are refractory for more conservative treatments.Neuromodulation in CRPS patients has to be performed in specialized centers that are able to diagnose the underlying mechanisms of the disease and apply the right stimulation therapy.RecommendationsDescriptionStrength of recommendationLevel of evidenceSpinal Cord Stimulation should be used in complex regional pain syndrome patients who are refractory to conservative treatments. ModerateModerateDescriptionStrength of recommendationLevel of evidenceDorsal Root Ganglion Stimulation should be used for patients with complex regional pain syndrome of the lower extremity who are refractory to conservative treatments, and is superior to spinal cord stimulation at 12 months ModerateModeratePeripheral nerve stimulationLiterature overviewIn a prospective case series, peripheral nerve stimulation (PNS) with surgically placed plate type electrodes connected with an implantable pulse generator reduced allodynic and spontaneous pain in 19 (63%) out of 30 implanted patients with CRPS and symptoms in the distribution of 1 major peripheral nerve. ADDIN EN.CITE <EndNote><Cite><Author>Hassenbusch</Author><Year>1996</Year><RecNum>330</RecNum><DisplayText><style face="superscript">24</style></DisplayText><record><rec-number>330</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="0">330</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Hassenbusch, S. J.</author><author>Stanton-Hicks, M.</author><author>Schoppa, D.</author><author>Walsh, J. G.</author><author>Covington, E. C.</author></authors></contributors><auth-address>Department of Neurosurgery, M.D. Anderson Cancer Center, Houston, Texas, USA.</auth-address><titles><title>Long-term results of peripheral nerve stimulation for reflex sympathetic dystrophy</title><secondary-title>J Neurosurg</secondary-title></titles><periodical><full-title>J Neurosurg</full-title></periodical><pages>415-23</pages><volume>84</volume><number>3</number><keywords><keyword>*Electric Stimulation Therapy</keyword><keyword>Electrodes, Implanted</keyword><keyword>Female</keyword><keyword>Follow-Up Studies</keyword><keyword>Human</keyword><keyword>Linear Models</keyword><keyword>Male</keyword><keyword>Pain/etiology/therapy</keyword><keyword>Peripheral Nerves/*physiopathology</keyword><keyword>Prospective Studies</keyword><keyword>Reflex Sympathetic Dystrophy/physiopathology/*therapy</keyword></keywords><dates><year>1996</year><pub-dates><date>Mar</date></pub-dates></dates><accession-num>8609552</accession-num><urls><related-urls><url> In a retrospective study with 52 patients (48 CRPS-2 patients and 4 phantom limb patients), 47 patients were implanted after a positive trial stimulation. Of these patients, 43 (91%) had lasting excellent to good success with marked pain reduction and reduction of pain related disability ADDIN EN.CITE <EndNote><Cite><Author>Buschmann</Author><Year>1999</Year><RecNum>3490</RecNum><DisplayText><style face="superscript">25</style></DisplayText><record><rec-number>3490</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="0">3490</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Buschmann, D.</author><author>Oppel, F.</author></authors></contributors><auth-address>Neurochirurgische Klinik, Krankenanstalten Gilead, Bielefeld-Bethel.</auth-address><titles><title>[Peripheral nerve stimulation for pain relief in CRPS II and phantom-limb pain]</title><secondary-title>Schmerz</secondary-title></titles><periodical><full-title>Schmerz</full-title></periodical><pages>113-20</pages><volume>13</volume><number>2</number><edition>2003/06/12</edition><dates><year>1999</year><pub-dates><date>Apr 14</date></pub-dates></dates><orig-pub>Periphere Nervenstimulation.</orig-pub><isbn>0932-433X (Print)</isbn><accession-num>12799940</accession-num><urls><related-urls><url> Quality of the evidence DescriptionVery low There is evidence of very low quality that in complex regional pain syndrome peripheral nerve stimulation is effectively reduces pain during a long term follow up of 2-4 years and reduces pain related disabilityHassenbusch SJ et al. 1996; Buschmann D and Oppel F, 1999ConsiderationsThe clinical efficacy is only shown in a prospective case series and a retrospective study.The technique can only be applied if the pain is in the distribution of a peripheral nerve and therefore seems to be less suitable for the majority of CRPS patients.Serious adverse events are rare, adverse effects are more frequent and in the majority related to technical issues.Peripheral Nerve Stimulation in CRPS patients has to be performed in specialized centers that are able to diagnose the underlying mechanisms in the disease and apply the right stimulation therapy.RecommendationsDescriptionStrength of recommendationLevel of evidencePeripheral nerve stimulation could be considered in complex regional pain syndrome patients.Very weakVery lowKetamine intravenouslyLiterature overviewA review found moderate evidence for the efficacy of low-dose IV ketamine infusion in longstanding CRPS (two RCTs). ADDIN EN.CITE <EndNote><Cite><Author>Cossins</Author><Year>2013</Year><RecNum>12048</RecNum><DisplayText><style face="superscript">26</style></DisplayText><record><rec-number>12048</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="1472060737">12048</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Cossins, L.</author><author>Okell, R. W.</author><author>Cameron, H.</author><author>Simpson, B.</author><author>Poole, H. M.</author><author>Goebel, A.</author></authors></contributors><auth-address>Pain Research Institute, Clinical Sciences Centre, University Hospital Aintree, Liverpool, UK.</auth-address><titles><title>Treatment of complex regional pain syndrome in adults: a systematic review of randomized controlled trials published from June 2000 to February 2012</title><secondary-title>Eur J Pain</secondary-title></titles><periodical><full-title>Eur J Pain</full-title></periodical><pages>158-73</pages><volume>17</volume><number>2</number><keywords><keyword>Adult</keyword><keyword>Causalgia/diagnosis/drug therapy/rehabilitation</keyword><keyword>Complex Regional Pain Syndromes/diagnosis/drug therapy/rehabilitation/*therapy</keyword><keyword>Humans</keyword><keyword>Imagery (Psychotherapy)</keyword><keyword>Pain Management</keyword><keyword>Randomized Controlled Trials as Topic</keyword><keyword>Reflex Sympathetic Dystrophy/diagnosis/drug therapy/rehabilitation</keyword><keyword>Research Design</keyword><keyword>Transcranial Magnetic Stimulation</keyword><keyword>Treatment Outcome</keyword></keywords><dates><year>2013</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>1532-2149 (Electronic)
1090-3801 (Linking)</isbn><accession-num>23042687</accession-num><urls><related-urls><url> IV infusion of low-dose ketamine (4.5 days of continuous treatment or 10 consecutive working days of outpatient treatment) significantly reduced pain compared with placebo in one high-quality ADDIN EN.CITE <EndNote><Cite><Author>Sigtermans</Author><Year>2009</Year><RecNum>4634</RecNum><DisplayText><style face="superscript">27</style></DisplayText><record><rec-number>4634</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="0">4634</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Sigtermans, M.</author><author>Noppers, I.</author><author>Sarton, E.</author><author>Bauer, M.</author><author>Mooren, R.</author><author>Olofsen, E.</author><author>Dahan, A.</author></authors></contributors><auth-address>Department of Anesthesiology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands.</auth-address><titles><title>An observational study on the effect of S(+)-ketamine on chronic pain versus experimental acute pain in Complex Regional Pain Syndrome type 1 patients</title><secondary-title>Eur J Pain</secondary-title></titles><periodical><full-title>Eur J Pain</full-title></periodical><dates><year>2009</year><pub-dates><date>Jun 17</date></pub-dates></dates><accession-num>19540140</accession-num><urls><related-urls><url> and one low-quality trial ADDIN EN.CITE <EndNote><Cite><Author>Schwartzman</Author><Year>2009</Year><RecNum>4635</RecNum><DisplayText><style face="superscript">28</style></DisplayText><record><rec-number>4635</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="0">4635</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Schwartzman, R. J.</author><author>Alexander, G. M.</author><author>Grothusen, J. R.</author><author>Paylor, T.</author><author>Reichenberger, E.</author><author>Perreault, M.</author></authors></contributors><auth-address>Department of Neurology, Drexel University College of Medicine, Philadelphia, PA 19102, USA. Robert.schwartzman@drexelmed.edu</auth-address><titles><title>Outpatient intravenous ketamine for the treatment of complex regional pain syndrome: a double-blind placebo controlled study</title><secondary-title>Pain</secondary-title></titles><periodical><full-title>Pain</full-title></periodical><pages>107-15</pages><volume>147</volume><number>1-3</number><dates><year>2009</year><pub-dates><date>Dec 15</date></pub-dates></dates><accession-num>19783371</accession-num><urls><related-urls><url> in long-standing CRPS. ConclusionQuality of the evidence DescriptionModerate There is evidence of moderate quality that low dose intravenous ketamine reduces pain at 3 months follow up in long-standing complex regional pain syndrome. There is no effect on the functionality and quality of life.Sigtermans M et al. 2009; Schwartzman RJ et al. 2009ConsiderationsIf intractable pain persists, treatment with low-dose IV ketamine in CRPS can be considered. However, which dose and how long is unclear. Strong central effects (hallucination or addiction) and liver insufficiency have been reported in up to 20% of the patients especially after repeated administration. There are important safety concerns regarding repeated exposure to ketamine.The liver functions have to be monitored frequently; if the liver functions (SGOT and SGPT) increase, the IV ketamine should be stopped immediately. The use of ketamine for the treatment of chronic pain is off-label therefore written informed consent is mandatory. This treatment should only be applied in monitored conditions.RecommendationDescriptionStrength of recommendationLevel of evidenceLow dose intravenous ketamine could be considered in complex regional pain syndrome patients.WeakModerateReferences ADDIN EN.REFLIST 1Straube S, Derry S, Moore RA, Cole P. Cervico-thoracic or lumbar sympathectomy for neuropathic pain and complex regional pain syndrome. Cochrane Database Syst Rev. 2013:CD002918.2Manjunath PS, Jayalakshmi TS, Dureja GP, Prevost AT. Management of lower limb complex regional pain syndrome type 1: an evaluation of percutaneous radiofrequency thermal lumbar sympathectomy versus phenol lumbar sympathetic neurolysis--a pilot study. Anesth Analg. 2008;106:647-649.3van Eijs F, Stanton-Hicks M, Van Zundert J, et al. Evidence-based interventional pain medicine according to clinical diagnoses. 16. Complex regional pain syndrome. Pain Pract. 2011;11:70-87.4Azari P, Lindsay DR, Briones D, Clarke C, Buchheit T, Pyati S. Efficacy and safety of ketamine in patients with complex regional pain syndrome: a systematic review. CNS Drugs. 2012;26:215-228.5Tran DQH, Duong S, Bertini P, Finlayson RJ. Treatment of complex regional pain syndrome: a review of the evidence. Can J Anaesth. 2010;57:149-166.6Xu J, Wong F, Cheng J. Intravenous therapies for complex regional pain syndrome-a systematic review. Regional Anesthesia and Pain Medicine. Conference: 11th Annual ASRA Pain Medicine Meeting Miami, FL United States. Conference Start: 20121115 Conference End: 20121118. Conference Publication: (var.pagings). 38 (1) , 2013. Date of Publication: January-February 2013. 2013.7O'Connell NE, Wand BM, McAuley J, Marston L, Moseley GL. Interventions for treating pain and disability in adults with complex regional pain syndrome. Cochrane Database Syst Rev. 2013;4:CD009416.8Connolly SB, Prager JP, Harden RN. A Systematic Review of Ketamine for Complex Regional Pain Syndrome. Pain Med. 2015.9Cossins L, Okell RW, Cameron H, Simpson B, Poole HM, Goebel A. Treatment of complex regional pain syndrome in adults: a systematic review of randomized controlled trials published from June 2000 to February 2012. Eur J Pain. 2013;17:158-173.10Stanton TR, Wand BM, Carr DB, Birklein F, Wasner GL, O'Connell NE. Local anaesthetic sympathetic blockade for complex regional pain syndrome. Cochrane Database Syst Rev. 2013:CD004598.11de Oliveira Rocha R, Teixeira MJ, Yeng LT, et al. Thoracic sympathetic block for the treatment of complex regional pain syndrome type I: a double-blind randomized controlled study. Pain. 2014;155:2274-2281.12Jadad AR, Carroll D, Glynn CJ, McQuay HJ. 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. 1995;10:13-20.13Ramamurthy 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;81:718-723.14Livingstone JA, Atkins RM. Intravenous regional guanethidine blockade in the treatment of post-traumatic complex regional pain syndrome type 1 (algodystrophy) of the hand. The Journal of bone and joint surgery. British volume. 2002;84:380-386.15Kemler MA, Barendse GA, van Kleef M, et al. Spinal cord stimulation in patients with chronic reflex sympathetic dystrophy. N Engl J Med. 2000;343:618-624.16Kemler MA, De Vet HC, Barendse GA, Van Den Wildenberg FA, Van Kleef M. The effect of spinal cord stimulation in patients with chronic reflex sympathetic dystrophy: two years' follow-up of the randomized controlled trial. Ann Neurol. 2004;55:13-18.17Forouzanfar T, Kemler MA, Weber WE, Kessels AG, van Kleef M. Spinal cord stimulation in complex regional pain syndrome: cervical and lumbar devices are comparably effective. Br J Anaesth. 2004;92:348-353.18Kemler MA, de Vet HC, Barendse GA, van den Wildenberg FA, van Kleef M. Effect of spinal cord stimulation for chronic complex regional pain syndrome Type I: five-year final follow-up of patients in a randomized controlled trial. J Neurosurg. 2008;108:292-298.19Simpson EL, Duenas A, Holmes MW, Papaioannou D, Chilcott J. Spinal cord stimulation for chronic pain of neuropathic or ischaemic origin: systematic review and economic evaluation. Health Technol Assess. 2009;13:iii, ix-x, 1-154.20Van Buyten JP, Smet I, Liem L, Russo M, Huygen F. Stimulation of dorsal root ganglia for the management of complex regional pain syndrome: a prospective case series. Pain Pract. 2015;15:208-216.21Deer TR, Levy RM, Kramer J, et al. Dorsal root ganglion stimulation yielded higher treatment success rate for complex regional pain syndrome and causalgia at 3 and 12 months: a randomized comparative trial. Pain. 2017;158:669-681.22Kriek N, Groeneweg JG, Stronks DL, de Ridder D, Huygen FJ. Preferred frequencies and waveforms for spinal cord stimulation in patients with complex regional pain syndrome: A multicentre, double-blind, randomized and placebo-controlled crossover trial. Eur J Pain. 2017;21:507-519.23Kemler MA, Furnee CA. Economic evaluation of spinal cord stimulation for chronic reflex sympathetic dystrophy. Neurology. 2002;59:1203-1209.24Hassenbusch SJ, Stanton-Hicks M, Schoppa D, Walsh JG, Covington EC. Long-term results of peripheral nerve stimulation for reflex sympathetic dystrophy. J Neurosurg. 1996;84:415-423.25Buschmann D, Oppel F. [Peripheral nerve stimulation for pain relief in CRPS II and phantom-limb pain]. Schmerz. 1999;13:113-120.26Cossins L, Okell RW, Cameron H, Simpson B, Poole HM, Goebel A. Treatment of complex regional pain syndrome in adults: a systematic review of randomized controlled trials published from June 2000 to February 2012. Eur J Pain. 2013;17:158-173.27Sigtermans M, Noppers I, Sarton E, et al. An observational study on the effect of S(+)-ketamine on chronic pain versus experimental acute pain in Complex Regional Pain Syndrome type 1 patients. Eur J Pain. 2009.28Schwartzman RJ, Alexander GM, Grothusen JR, Paylor T, Reichenberger E, Perreault M. Outpatient intravenous ketamine for the treatment of complex regional pain syndrome: a double-blind placebo controlled study. Pain. 2009;147:107-115. ................
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